In this systematic review, we report on the effects of diuretic deprescribing compared to continued diuretic use. We included clinical studies reporting on outcomes such as mortality, heart failure recurrence, tolerability and feasibility. We assessed risk of bias and certainty of the evidence using the GRADE framework. We included 25 publications from 22 primary studies (15 randomized controlled trials; 7 nonrandomized studies). The mean number of participants in the deprescribing groups was 35, and median/mean age 64 years. In patients with heart failure, there was no clear evidence that diuretic deprescribing was associated with increased mortality compared to diuretic continuation (low certainty evidence). The risk of cardiovascular composite outcomes associated with diuretic deprescribing was inconsistent (studies showing lower risk for diuretic deprescribing, or comparable risk with diuretic continuation; very low certainty evidence). The effect on heart failure recurrence after diuretic deprescribing in patients with diuretics for heart failure, and of hypertension in patients with diuretics for hypertension was inconsistent across the included studies (low certainty evidence). In patients with diuretics for hypertension, diuretic deprescribing was well tolerated (moderate certainty evidence), while in patients with diuretics for heart failure, deprescribing diuretics can result in complaints of peripheral oedema (very low certainty evidence). The overall risk of bias was generally high. In summary, this systematic review suggests that diuretic discontinuation could be a safe and feasible treatment option for carefully selected patients. However, there isa lack of high-quality evidence on its feasibility, safety and tolerability of diuretic deprescribing, warranting further research.
- MeSH
- depreskripce * MeSH
- diuretika * škodlivé účinky aplikace a dávkování terapeutické užití MeSH
- dospělí MeSH
- hypertenze farmakoterapie MeSH
- lidé MeSH
- medicína založená na důkazech MeSH
- randomizované kontrolované studie jako téma MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- srdeční selhání * farmakoterapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
Pancreas is a vital gland of gastrointestinal system with exocrine and endocrine secretory functions, interweaved into essential metabolic circuitries of the human body. Pancreatic ductal adenocarcinoma (PDAC) represents one of the most lethal malignancies, with a 5-year survival rate of 11%. This poor prognosis is primarily attributed to the absence of early symptoms, rapid metastatic dissemination, and the limited efficacy of current therapeutic interventions. Despite recent advancements in understanding the etiopathogenesis and treatment of PDAC, there remains a pressing need for improved individualized models, identification of novel molecular targets, and development of unbiased predictors of disease progression. Here we aim to explore the concept of precision medicine utilizing 3-dimensional, patient-specific cellular models of pancreatic tumors and discuss their potential applications in uncovering novel druggable molecular targets and predicting clinical parameters for individual patients.
- MeSH
- duktální karcinom pankreatu * patologie genetika metabolismus MeSH
- individualizovaná medicína * metody MeSH
- lidé MeSH
- nádory slinivky břišní * patologie genetika MeSH
- techniky 3D buněčné kultury metody MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- kojenecká mortalita MeSH
- lidé MeSH
- náhlé příhody * epidemiologie klasifikace MeSH
- neonatologie * MeSH
- novorozenec MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
In recent years, several international urological societies have published guidelines on the diagnosis, treatment, and follow-up of urethral strictures, but a guideline for the German-speaking region has not been available to date. This summary provides a detailed comparison of the guidelines of the European Association of Urology (EAU), American Urological Association (AUA) and the Société Internationale d'Urologie (SIU) with regard to the treatment of anterior urethral strictures, i.e. from the bulbar urethra to the meatus. In the following work, differences and specific recommendations in the guidelines are highlighted. In particular, the three guidelines largely agree with regard to diagnostic workup and follow-up. However, divergences exist in the management of anterior urethral strictures, particularly with regard to the use of endoscopic therapeutic approaches and the use of urethral stents. In addition, the EAU provides more comprehensive and detailed recommendations on urethroplasty techniques and specific patient follow-up. The EAU guidelines are the most current and were the first to include instructions for urethral strictures in women and individuals with gender incongruence after genital approximation surgery. Reconstructive urology is a rapidly evolving specialty and, thus, the clinical approach has been changing accordingly. Although guideline recommendations have become more inclusive and comprehensive, more high-quality data are needed to further improve the level of evidence.
- MeSH
- lidé MeSH
- správnost dat MeSH
- striktura uretry * diagnóza MeSH
- uretra chirurgie MeSH
- urologie * MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Spojené státy americké MeSH
Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.
- MeSH
- behaviorální vědy * metody trendy MeSH
- COVID-19 * epidemiologie etnologie prevence a kontrola MeSH
- komunikace MeSH
- kultura MeSH
- lékařská praxe založená na důkazech * metody MeSH
- lidé MeSH
- pandemie * prevence a kontrola MeSH
- sociální normy MeSH
- veřejné zdravotnictví metody trendy MeSH
- vůdcovství MeSH
- vytváření politiky * MeSH
- zdravotní politika * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
V současné době neexistuje mezinárodní konsenzus, který by zahrnoval chirurgický výkon v rámci standardu léčby metastatického karcinomu pankreatu. Přestože dosud existuje málo důkazů pro obecné zavedení chirurgické resekce v léčbě metastatického karcinomu pankreatu, tak ve vzácných případech pouze oligometastatického rozsevu přibývá sdělení, že chirurgická intervence může vést k příznivým výsledkům. Individualizace péče a terapie na míru (tailored therapy) se netýká pouze cílené léčby, ale celé komplexní onkologické péče, vč. indikace k chirurgickému výkonu. Tento přehled shrnuje současný stav kombinované onkochirurgické léčby v multidisciplinární léčbě oligometastatického karcinomu pankreatu spolu s vlastními zkušenostmi a diskutuje budoucí perspektivy, zejména stran prognostických a prediktivních faktorů, které by tuto skupinu dokázaly lépe predikovat.
Currently, no international consensus includes surgery as part of the standard of metastatic pancreatic ductal adenocarcinoma care. There is weak evidence to support the general introduction of surgical resection in the metastatic pancreatic ductal adenocarcinoma treatment. However, in the rare cases of oligometastatic spread there is increasing evidence that surgical intervention can lead to favourable outcomes. Individualisation of the care and tailored therapy refers not only to targeted treatment but also to the whole complex cancer care, including the indication for surgery. This review summarizes the current status of combined oncosurgical therapy in the multidisciplinary management of oligometastatic pancreatic cancer, together with our own experience, and discusses future perspectives, particularly regarding prognostic and predictive factors that could better predict this group.
- MeSH
- analýza přežití MeSH
- dospělí MeSH
- individualizovaná medicína * MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázektomie MeSH
- metastázy nádorů terapie MeSH
- nádory slinivky břišní * terapie MeSH
- neoadjuvantní terapie MeSH
- prognóza MeSH
- protokoly antitumorózní kombinované chemoterapie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
Non-formal adult education and learning (NAE) is widely recognized as enhancing the quality of life and promoting active aging. Despite the empirically demonstrated benefits, older adults rank among one of the populations participating the least in NAE. Although several studies have highlighted the negative effect of aging on involvement in NAE, factors causing long-term changes in participation have not been explored directly. As a result, the significance of microsocial characteristics and their transformation over time has been overlooked. This article explores key microsocial factors leading to non/participation in NAE among adults aged 50 to 69 years along with changes in these factors for the 14-year period of 2006 to 2019. The research was conducted using the Czech Republic's Labor Force Survey dataset (N = 114,345). The results show that all microsocial factors play an essential role in determining participation in NAE, thus a strong relationship between the social origins (cumulative disadvantage) of older adults and their participation was confirmed. In addition, the impact of most factors has proved consistent over time, not strengthening since 2009. One exception was level of education, which showed a rapid increase in participation in NAE in the respondents who identified themselves as low-educated.
- MeSH
- geriatrie * výchova MeSH
- kvalita života * MeSH
- lidé MeSH
- senioři MeSH
- stárnutí MeSH
- stupeň vzdělání MeSH
- zaměstnanost MeSH
- zapojení do společnosti MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND PURPOSE: Neurological disorders constitute a significant portion of the global disease burden, affecting >30% of the world's population. This prevalence poses a substantial threat to global health in the foreseeable future. A lack of awareness regarding this high burden of neurological diseases has led to their underrecognition, underappreciation, and insufficient funding. Establishing a strategic and comprehensive research agenda for brain-related studies is a crucial step towards aligning research objectives among all pertinent stakeholders and fostering greater societal awareness. METHODS: A scoping literature review was undertaken by a working group from the European Academy of Neurology (EAN) to identify any existing research agendas relevant to neurology. Additionally, a specialized survey was conducted among all EAN scientific panels, including neurologists and patients, inquiring about their perspectives on the current research priorities and gaps in neurology. RESULTS: The review revealed the absence of a unified, overarching brain research agenda. Existing research agendas predominantly focus on specialized topics within neurology, resulting in an imbalance in the number of agendas across subspecialties. The survey indicated a prioritization of neurological disorders and research gaps. CONCLUSIONS: Building upon the findings from the review and survey, key components for a strategic and comprehensive neurological research agenda in Europe were delineated. This research agenda serves as a valuable prioritization tool for neuroscientific researchers, as well as for clinicians, donors, and funding agencies in the field of neurology. It offers essential guidance for creating a roadmap for research and clinical advancement, ultimately leading to heightened awareness and reduced burden of neurological disorders.
- MeSH
- globální zátěž nemocemi MeSH
- lidé MeSH
- nemoci nervového systému * epidemiologie terapie MeSH
- neurologie * MeSH
- výzkum MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
