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Nonvestibular schwannoma tumors in the cerebellopontine angle: A structured approach and management guidelines

SKULL BASE-AN INTERDISCIPLINARY APPROACH 2008年第4期18卷 217-227页

作者： Springborg, Jacob Bertram Poulsgaard, Lars Thomsen, Jens Univ Copenhagen Hosp Univ Clin Neurosurg DK-2100 Copenhagen Denmark Gentofte Univ Hosp ENT Dept Copenhagen Denmark

The most common cerebellopontine angle (CPA) tumor is a vestibular schwannoma, but one in five CPA tumors are not vestibular schwannomas. These tumors may require different management strategies. Compared with vestibular schwannomas, symptoms and signs from cranial nerve VIII are less frequent: other cranial nerve and cerebellar symptoms and signs predominate in patients with these less common CPA tumors. Computed tomography and magnetic resonance imaging often show features leading to the correct diagnosis. Treatment most often includes surgery, but a policy of observation or subtotal resection is often wiser. This review provides a structured approach to the diagnosis of nonvestibular schwannoma CPA lesions and also management guidelines.

关键词： cerebellopontine angle epidermoids meningiomas tumors management guidelines

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Costello syndrome: Clinical phenotype, genotype, and management guidelines

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AMERICAN JOURNAL OF MEDICAL GENETICS PART A 2019年第9期179卷 1725-1744页

作者： Gripp, Karen W. Morse, Lindsey A. Axelrad, Marni Chatfield, Kathryn C. Chidekel, Aaron Dobyns, William Doyle, Daniel Kerr, Bronwyn Lin, Angela E. Schwartz, David D. Sibbles, Barbara J. Siegel, Dawn Shankar, Suma P. Stevenson, David A. Thacker, Mihir M. Weaver, K. Nicole White, Sue M. Rauen, Katherine A. Alfred I DuPont Hosp Children Dept Pediat Div Med Genet Wilmington DE USA Ferre Inst Binghamton NY USA Baylor Coll Med Dept Pediat Psychol Sect Houston TX 77030 USA Univ Colorado Sch Med Dept Pediat Sect Cardiol Aurora CO USA Alfred I DuPont Hosp Children Dept Pediat Div Pulmonol Wilmington DE USA Seattle Childrens Hosp Div Med Genet Seattle WA USA Alfred I DuPont Hosp Children Div Endocrinol Wilmington DE USA Univ Manchester Manchester Ctr Genom Med Manchester Lancs England MassGen Hosp Children Dept Pediat Med Genet Unit Boston MA USA Erasmus MC Sophia Childrens Hosp Div Pediat Rotterdam Netherlands Med Coll Wisconsin Dept Dermatol Milwaukee WI 53226 USA Univ Calif Davis Dept Pediat Div Genom Med Sacramento CA 95817 USA Stanford Univ Dept Pediat Div Med Genet Palo Alto CA 94304 USA Nemoirs Alfred I duPont Hosp Children Dept Orthoped Surg Wilmington DE USA Univ Cincinnati Coll Med Cincinnati Childrens Hosp Med Ctr Div Human Genet Cincinnati OH USA Royal Childrens Hosp Victorian Clin Genet Serv Melbourne Vic Australia

Costello syndrome (CS) is a RASopathy caused by activating germline mutations in HRAS. Due to ubiquitous HRAS gene expression, CS affects multiple organ systems and individuals are predisposed to cancer. Individuals with CS may have distinctive craniofacial features, cardiac anomalies, growth and developmental delays, as well as dermatological, orthopedic, ocular, and neurological issues;however, considerable overlap with other RASopathies exists. Medical evaluation requires an understanding of the multifaceted phenotype. Subspecialists may have limited experience in caring for these individuals because of the rarity of CS. Furthermore, the phenotypic presentation may vary with the underlying genotype. These guidelines were developed by an interdisciplinary team of experts in order to encourage timely health care practices and provide medical management guidelines for the primary and specialty care provider, as well as for the families and affected individuals across their lifespan. These guidelines are based on expert opinion and do not represent evidence-based guidelines due to the lack of data for this rare condition.

关键词： Costello syndrome HRAS mutation management guidelines RAS MAPK RASopathy

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Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery

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BMC HEALTH SERVICES RESEARCH 2013年第1期13卷 1-12页

作者： Bar-Zeev, Sarah J. Kruske, Sue G. Barclay, Lesley M. Bar-Zeev, Naor Kildea, Sue V. Univ Sydney Sydney Sch Publ Hlth Sydney NSW 2480 Australia Univ Queensland Queensland Ctr Mothers & Babies Sch Psychol Brisbane Qld 4072 Australia Ctr Rural Hlth Sydney NSW 2480 Australia Univ Sydney Sydney NSW 2480 Australia Charles Darwin Univ Menzies Sch Hlth Res Sydney NSW 0909 Australia Australian Catholic Univ Midwifery Res Unit Brisbane Qld 4010 Australia Mater Med Res Inst Brisbane Qld 4010 Australia Univ Liverpool Inst Infect & Global Hlth Malawi Liverool Wellcome Trust Clin Res Programme Liverpool L69 3BX Merseyside England

Background: Remote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings. Methods: A mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004-2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians' perspectives on barriers to effective remote health service delivery. Results: Data from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians' to impact upon the quality of service delivery. Conclusion: Among Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians' adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care pro

关键词： Aboriginal Adherence Anaemia Australia Barriers Growth faltering Infant management guidelines Primary health care Remote Quality of care

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Aortic Regurgitation: Review of the Diagnostic Criteria and the management guidelines

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CURRENT CARDIOLOGY REPORTS 2023年第10期25卷 1373-1380页

作者： Malahfji, Maan Saeed, Mujtaba Zoghbi, William A. Houston Methodist DeBakey Heart & Vasc Ctr Dept Cardiol 6550 Fannin StSmith TowerSuite 1801 Houston TX 77030 USA

Purpose of Review The evaluation of aortic regurgitation (AR) has advanced from physical examination and angiography towards evidence based non-invasive quantitative methods, primarily with echocardiography and more recently with cardiac magnetic resonance (CMR). This review highlights the guidelines and recent evidence in the diagnosis and management of AR;and outlines future areas of research. Recent Findings Contemporary large cohorts of AR patients studied with echocardiography and CMR suggest that the left ventricular remodeling and systolic function triggers for intervention may be lower than previously recommended in the guidelines and emphasize the importance of LV volumes in risk stratification. Summary Important gaps of knowledge in the quantitation of AR severity and patient risk stratification were fulfilled recently. Potential thresholds for intervention using ventricular volumes and CMR quantitative findings were recently described. The criteria for what constitutes hemodynamically significant AR and the optimal timing of intervention AR deserve further study.

关键词： Aortic regurgitation Aortic valve surgery Echocardiography management guidelines Cardiac magnetic resonance

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INTRATHECAL INFUSIONAL THERAPIES FOR INTRACTABLE PAIN - PATIENT-management guidelines

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JOURNAL OF PAIN AND SYMPTOM management 1993年第1期8卷 36-46页

作者： KRAMES, ES San Francisco Center for Comprehensive Pain Management San Francisco California USA

This article focuses on appropriate patient selection for and management of patients selected for continuous spinal infusional opioid therapy. Patients with cancer-related pain who have undergone sequential strong opioid drug trials, who have intractable, unmanageable side effects, and who have undergone a successful spinal opioid efficacy trial are candidates for implantable spinal infusional therapy. Patients with noncancer-related chronic pain, who have failed all conventional syndrome-specific therapies before neuroablative surgical procedures, including sequential strong opioid drug trials, who have intractable, unmanageable side effects, and who have undergone successful spinal opioid efficacy trial are deemed candidates for implantable spinal infusional therapy. Patients with chronic noncancer-related pain and patients with cancer-related pain who have life expectancies greater than 3 mo all have implanted programmable infusion pumps. Patients with cancer-related pain who have life expectancies less than 3 mo have implanted permanent epidural catheters connected to external pump systems. management guidelines for complications of therapy broadly categorized as surgical, mechanical, and pharmacologic are presented.

关键词： INTRATHECAL OPIOIDS CHRONIC INFUSIONAL THERAPY INTRATHECAL NARCOTICS management guidelines PATIENT SELECTION COMPLICATIONS

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Adherence to management guidelines in acute respiratory infections and diarrhoea in children under 5 years old in primary health care in Botswana

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INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE 2005年第3期17卷 221-227页

作者： Boonstra, E Lindbæk, M Ngome, E Univ Oslo Dept Gen Practice & Community Med Oslo Norway Univ Botswana Dept Populat Studies Gaborone Botswana

Objective. To evaluate health care providers' adherence to management guidelines for acute respiratory infection and diarrhoea in children under 5 years old in Botswana primary health care. Design. Cross-sectional prospective field survey. Data collection was carried out through observation of consecutive consultations at 30 randomly assigned clinics and health posts in three purposely chosen districts. Study participants. This study comprises 185 cases of acute respiratory infection and 85 cases of diarrhoea. Main measures. Criteria for acceptable standards of history taking and physical examination for acute respiratory infection and diarrhoea were defined as well as criteria for categorizing the appropriateness of antibiotic prescription. The percentage of oral dehydration salts provided in cases of diarrhoea was calculated. Results. Acute respiratory infection and diarrhoea accounted for 270 (including 15 missing cases) of all main diagnoses (n = 539). In 262 cases (97%) health care providers were nurses or enrolled nurses;in 3% family welfare educators. Acceptable history taking, physical examination, and both combined in acute respiratory infection was found in 113 (63%), 32 (18%), and 28 (16%), and in diarrhoea in 45 (58%), 26 (34%) and 20 (26%) cases, respectively. Antibiotics were prescribed in 76 of 255 (30%) cases. Prescription was assessed as inappropriate in 56 of 76 (74%) of all cases;in 41 of 52 (79%) cases with acute respiratory infection, in none of the pneumonia cases, and in all 15 cases of diarrhoea. Oral rehydration salts were prescribed in 74 (87%) of the diarrhoea cases. Conclusions. Health care providers' adherence to guidelines on history taking was suboptimal in acute respiratory infection and diarrhoea but poor on examination in both conditions. A high level of inappropriate antibiotic prescription was found in acute respiratory infection and diarrhoea. Overall, there is considerable scope for improving diagnostic and therapeutic managemen

关键词： acute respiratory infections adherence Botswana children under 5 years old diarrhoea management guidelines primary health care

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Chronic urticaria: a comparison of management guidelines

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EXPERT OPINION ON PHARMACOTHERAPY 2011年第17期12卷 2683-2693页

作者： Ortonne, Jean-Paul Hop Archer Serv Dermatol F-06202 Nice 03 France

Introduction: Chronic urticaria is characterized by recurring episodes of spontaneous transient dermal wheals and pruritus, with or without angioedema, which can persist for 6 weeks. Chronic urticaria impairs quality of life, emphasizing the need for effective treatments. Professional societies and clinical experts have issued evidence-based recommendations for the management of chronic urticaria, including recommending the use of second-generation antihistamines as a first-line therapy. Areas covered: A Medline search was conducted from 2000 to 2011 using the following terms, alone or in combination: 'chronic urticaria', 'management guidelines', 'consensus guidelines' and 'expert opinions'. Ten management guidelines/expert opinions met the inclusion criteria. Expert opinion: There was a universal agreement among the articles reviewed, that low-sedating, second-generation antihistamines should be prescribed as a first-line treatment of chronic urticaria. For refractory urticaria, however, recommendations varied and included dose escalation of second-generation antihistamines and adjunctive treatments with other agents of the same class, such as sedating antihistamines or leukotriene receptor antagonists. More research into effective second-line treatments and consistent implementation of current guidelines is needed, to ensure that treatment is based on clinical evidence.

关键词： antihistamines chronic urticaria expert opinion management guidelines second-generation uptitration

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Glycogen storage disease type III diagnosis and management guidelines (vol 12, pg 446, 2010)

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GENETICS IN MEDICINE 2010年第9期12卷 566-566页

作者： Kishnani, P. S. Austin, S. L. Arn, P. Bali, D. S. Boney, A. Case, L. E. American College of Medical Genetics Bethesda Maryland

Purpose: Glycogen storage disease type III is a rare disease of variable clinical severity affecting primarily the liver, heart, and skeletal muscle. It is caused by deficient activity of glycogen debranching enzyme, which is a key enzyme in glycogen degradation. Glycogen storage disease type III manifests a wide clinical spectrum. Individuals with glycogen storage disease type III present with hepatomegaly, hypoglycemia, hyperlipidemia, and growth retardation. Those with type IIIa have symptoms related to liver disease and progressive muscle (cardiac and skeletal) involvement that varies in age of onset, rate of disease progression, and severity. Those with type IIIb primarily have symptoms related to liver disease. This guideline for the management of glycogen storage disease type III was developed as an educational resource for health care providers to facilitate prompt and accurate diagnosis and appropriate management of patients.

关键词： glycogen storage disease type III Cori disease Forbes disease limit dextrinosis debranching enzyme deficiency management guidelines

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Managing Groundwater Nitrate Contamination from Livestock Farms: Implication for Nitrate management guidelines

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CURRENT POLLUTION REPORTS 2016年第3期2卷 178-187页

作者： Sahoo, Prafulla Kumar Kim, Kangjoo Powell, M. A. Vale Inst Technol BR-66055090 Belem Para Brazil Kunsan Natl Univ Dept Environm Engn Jeonbuk 573701 South Korea Univ Alberta Dept Renewable Resources Fac Agr Life & Environm Sci Edmonton AB T6G 2R3 Canada

Significant nitrate contamination of groundwater has been observed in various parts of the world;intensive livestock farming is one of the major causes. This paper reviews various guidelines/regulations, which have been developed in advanced countries such as USA, Canada, Australia, and Europe to combat this problem by designing effective monitoring and management programs. Monitoring programs deal mainly with selection of sites, number of monitoring wells, specific parameters, and sampling frequency, which are helpful for identifying the source and extend of the contamination. management programs deal with selection of suitable location, site characterization, proximity of livestock facilities and drinking wells, and proper storage, maintenance of the facilities, and limits of manures application in order to minimize nitrate leaching into groundwater. The main aim of this paper is to help states/countries, which do not have any guideline, and consulting engineers/consultants/owners of livestock operation in the design of effective strategies for point source nitrate management.

关键词： Nitrate contamination Livestock Groundwater management guidelines

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Lower limb occlusive arterial disease in the North of England: Workload and development of management guidelines

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EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2000年第3期20卷 260-267页

作者： Huntington, FM Prentis, F Hildreth, AJ Holdsworth, J Cumberland Infirm Dept Surg Carlisle CA2 7HY England Freeman Rd Hosp Dept Clin Audit Newcastle Upon Tyne NE7 7DN Tyne & Wear England City Hosp Dept Stat Sunderland England

Background: in 1997 the vascular surgeons across the North of England commenced a study to examine,nine various aspects of the management of lower limb occlusive arterial disease (LLOAD). Two aspects of this work were to assess workloads between hospitals and develop guideline parameters for managing intermittent claudication (IC) and critical limb ischaemia (CLI). The guidelines were to be developed, tested and modified by this study. Method: prospective inclusion of all patients admitted for investigation of LLOAD to nine hospitals by 19 surgeons over a period of 12 months. Results: the hospitals admitted an average of 106 legs per 100 000 population (range 53-149) with LLOAD. Legs with IC (n = 1351) were revascularised slightly less frequently than predicted (actual 76%, guideline 80%) and radiological treatment was used more frequently than predicted (radiology/surgery, actual 69/32%, guideline 40/60%). For limbs with CLI, revascularisation was undertaken move often (actual 70%, guideline 60%) and radiological intervention used more frequently (radiology/surgery, actual 45/58%, guideline 35/65%) than anticipated. Primary amputation, overall mortality and limb salvage were better than the predicted guidelines. Conclusion: large variations in workloads and clinical practice were observed between hospitals for the management of LLOAD. Developing guidelines for the management of limbs with IC was not considered appropriate, whereas suitable guidelines for legs with CLI were developed, tested and modified.

关键词： peripheral vascular disease intermittent claudication critical limb ischaemia workload management guidelines

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