Global obesity rates have risen dramatically, now exceeding deaths from starvation. Metabolic and bariatric surgery (MBS), initially for severe obesity (BMI ≥35 kg/m2), is performed globally over 500 000 times annually, offering significant metabolic benefits beyond weight loss. However, varying eligibility criteria globally impact patient care and healthcare resources. Updated in 2022, ASMBS and IFSO guidelines aim to standardise MBS indications, reflecting current understanding and emphasising comprehensive preoperative assessments. Yet, clinical variability persists, necessitating consensus-based recommendations. This modified Delphi study engaged 45 global experts to establish consensus on perioperative management in MBS. Experts selected from bariatric societies possessed expertise in MBS and participated in a two-round Delphi protocol. Consensus was achieved on 90 of 169 statements (53.3%), encompassing multidisciplinary team composition, patient selection criteria, preoperative testing, and referral pathways. The agreement highlighted the critical role of comprehensive preoperative assessments and the integration of healthcare professionals in MBS. These findings offer essential insights to standardise perioperative practices and advocate for evidence-based guidelines in MBS globally. The study underscores the need for unified protocols to optimise outcomes and guide future research in MBS.
- MeSH
- Bariatric Surgery * standards methods MeSH
- Delphi Technique * MeSH
- Consensus * MeSH
- Humans MeSH
- Obesity, Morbid surgery MeSH
- Preoperative Care * standards methods MeSH
- Patient Selection MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Systematic strategies for preventing and treating esophagogastric variceal rebleeding (EVRB) are currently inadequate. This systematic review aimed to update this critical gap by searching contemporary studies from major guideline websites, databases, and professional associations focused on EVRB prevention in cirrhosis patients. Key findings highlight evaluation methods, risk management, preventive measures, health education, and follow-up strategies. Notably, a hepatic venous pressure gradient exceeding 18 mmHg is identified as a reliable predictor of gastroesophageal varices (GOV) rebleeding. Effective management of primary diseases is crucial, with methods including antiviral and anti-fibrotic therapies, alcohol avoidance, vaccination, and careful medication management. The combination of nonselective β-blockers (NSBBs) and endoscopic variceal ligation (EVL) is established as the gold standard for secondary EVRB prevention. For patients experiencing recurrent bleeding despite NSBBs and EVL, transjugular intrahepatic portosystemic shunt (TIPS) therapy is recommended. Surgical options, such as surgical shunt and devascularization, are advised for those unsuitable for endoscopic therapy or TIPS, particularly in Child-Pugh A and B patients unresponsive to treatment. Additionally, traditional Chinese medicine options, such as Fufang Biejia Ruangan Tablets, Fuzheng Huayu Capsules, and Anluo Huaxian Pills, have shown promise in improving hepatic fibrosis and GOV in cirrhotic patients. This review offers a comprehensive overview of current prevention and treatment strategies for EVRB, providing valuable insights for clinicians and healthcare professionals.
AIM: To examine the organisational (i.e., perceived organisational support and psychologically safe environment) and individual (i.e., value, belief and norm) antecedents that strengthen healthcare workers' speaking-up behaviour in a developing economy. DESIGN: The study uses a cross-sectional design to gather the same data from healthcare workers within the Ashanti Region of Ghana. METHODS: The data collection happened between 15 June and 30 August 2023. A sample of 380 healthcare workers was selected from 20 facilities in the Ashanti Region of Ghana. A configurational approach, a fussy-set qualitative comparative analysis, was used to identify the configurations that caused high and low speaking-up behaviour among the study sample. RESULTS: The study results reveal that whereas four configurations generate high speaking-up behaviour, three configurations, by contrast, produce low speaking-up behaviour among healthcare workers. CONCLUSION: Results suggest that in so far as organisational support systems which take the form of a psychologically safe environment and perceived organisational support are vital in relaxing the hierarchical boundaries in a healthcare setting to improve healthcare workers' speaking-up behaviour, the individual value-based factors that take the form of values, beliefs and norms are indispensable as it provides the healthcare workers with the necessary inner drive to regard speaking-up behaviour on patient safety and care as a moral duty. IMPACT: Healthcare workers' speaking-up behaviour is better achieved when organisational support systems complement the individual norms, values and beliefs of the individual. REPORTING METHOD: Adhered to Strengthening Reporting of Observational Studies in Epidemiology guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
- MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Organizational Culture * MeSH
- Attitude of Health Personnel * MeSH
- Cross-Sectional Studies MeSH
- Health Personnel * psychology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Ghana MeSH
PURPOSE: The use of thyroid hormones (TH) to treat obesity is unsupported by evidence as reflected in international guidelines. We explored views about this practice, and associations with respondent characteristics among European thyroid specialists. METHODS: Specialists from 28 countries were invited to a survey via professional organisations. The relevant question was whether "Thyroid hormones may be indicated in biochemically euthyroid patients with obesity resistant to lifestyle interventions". RESULTS: Of 17,232 invitations 5695 responses were received (33% valid response rate; 65% women; 90% endocrinologists). Of these, 290 (5.1%) stated that TH may be indicated as treatment for obesity in euthyroid patients. This view was commoner among non-endocrinologists (8.7% vs. 4.7%, p < 0.01), private practice (6.5% vs. 4.5%, p < 0.01), and varied geographically (Eastern Europe, 7.3%; Southern Europe, 4.8%; Western Europe, 2.7%; and Northern Europe, 2.5%). Respondents from Northern and Western Europe were less likely to use TH than those from Eastern Europe (p < 0.01). Gross national income (GNI) correlated inversely with this view (OR 0.97, CI: 0.96-0.97; p < 0.001). Having national guidelines on hypothyroidism correlated negatively with treating obesity with TH (OR 0.71, CI: 0.55-0.91). CONCLUSIONS: Despite the lack of evidence, and contrary to guidelines' recommendations, about 5% of respondents stated that TH may be indicated as a treatment for obesity in euthyroid patients resistant to life-style interventions. This opinion was associated with (i) respondent characteristics: being non-endocrinologist, working in private practice, treating a small number of hypothyroid patients annually and (ii) national characteristics: prevalence of obesity, Eastern Europe, low GNI and lack of national hypothyroidism guidelines.
- MeSH
- Adult MeSH
- Thyroid Hormones * blood MeSH
- Hypothyroidism epidemiology therapy drug therapy MeSH
- Practice Patterns, Physicians' statistics & numerical data standards MeSH
- Middle Aged MeSH
- Humans MeSH
- Obesity * epidemiology therapy MeSH
- Surveys and Questionnaires MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
Léčebné možnosti pacientů s CMP se v posledních dekádách dramaticky změnily díky pokroku v rekanalizační terapii a dalších intervenčních postupech. Zatímco akutní léčba ischemické CMP se stala vysoce standardizovanou, v oblasti sekundární prevence a rehabilitace dosud existuje značná variabilita. Totéž platí pro management pacientů s intracerebrálním krvácením. Klíčovým krokem k dosažení standardizace napříč zdravotnickými zařízeními je sjednocení lékařské dokumentace, zejména propouštěcí zprávy. Tento článek představuje doporučený standard propouštěcí zprávy pro pacienty s ischemickou i hemoragickou CMP. Jeho hlavním cílem je zajistit jednotnou kvalitu zdravotní péče, zlepšit komunikaci mezi zdravotníky, podpořit sekundární prevenci a usnadnit digitalizaci a vědecký výzkum. Doporučený standard definuje minimální sadu klíčových informací, které by měla obsahovat každá propouštěcí zpráva pacientů s CMP. Součástí dokumentu jsou také šablony příjmové zprávy a epikrízy, které reflektují požadavky mezinárodního registru RES-Q a mohou usnadnit sběr dat. Implementace tohoto standardu přinese nejen snížení administrativní zátěže lékařů, ale zároveň umožní lepší kontrolu kvality péče a zajištění souladu s aktuálními klinickými doporučeními. Standardizace dokumentace představuje důležitý krok k optimalizaci léčby CMP a ke zlepšení dlouhodobých výsledků pacientů.
Treatment options for patients with stroke have dramatically evolved in recent decades due to advances in recanalization therapy and other interventional procedures. While acute treatment of ischemic stroke has become highly standardized, there remains significant variability in the areas of secondary prevention and rehabilitation. The same applies to the management of patients with intracerebral hemorrhage. A key step toward achieving standardization across healthcare facilities is the unification of medical documentation, particularly discharge reports. This article presents a recommended standard for discharge reports for patients with both ischemic and hemorrhagic strokes. Its main goal is to ensure uniform quality of healthcare, improve communication among medical professionals, support secondary prevention, and facilitate digitalization and scientific research. The recommended standard defines the minimum set of essential information that every discharge report for stroke patients should contain. The document also includes templates for admission reports and epicrises, which reflect the requirements of the international RES-Q registry and can facilitate data collection. The implementation of this standard will not only reduce the administrative burden on physicians, but also enable better quality control of care and ensure compliance with current clinical guidelines. Standardizing documentation represents an important step toward optimizing stroke treatment and improving long-term patient outcomes.
- MeSH
- Stroke * MeSH
- Ischemic Stroke MeSH
- Humans MeSH
- Patient Discharge Summaries * standards MeSH
- Check Tag
- Humans MeSH
- Publication type
- Practice Guideline MeSH
Hepatectomies play a crucial role in the multidisciplinary management of primary and secondary liver malignancies but are associated with significant risks, including 30-day mortality, morbidity, prolonged hospitalization, and increased resource utilization. Optimizing perioperative care remains a challenge; however, enhanced recovery programs have shown improved patient outcomes. The EUPEMEN (EUropean PErioperative MEdical Networking) protocol focuses on improving the perioperative management of liver resections through the establishment of interdisciplinary principles based on practical experience and theoretical frameworks from five European countries. This paper outlines the core elements of the EUPEMEN protocol, emphasizing strategies to minimize surgical stress, optimize perioperative care, and enhance postoperative recovery. The protocol is systematically designed to reduce postoperative mortality and morbidity, shorten hospital stays, and improve patient outcomes. The EUPEMEN guidelines address inconsistencies in surgical practice across Europe and are structured for implementation in various healthcare environments. "The protocol's approach is designed to support improvements in perioperative care standards in liver resections and may serve as a practical and efficient tool for healthcare professionals, pending further clinical validation. The EUPEMEN protocol offers a standardized, evidence-based framework to enhance perioperative management in hepatectomies. By integrating multidisciplinary principles, the main target is to eliminate complications, improve surgical outcomes, and promote faster recovery. Its implementation across diverse clinical settings may contribute to advancing perioperative care standards for liver resections in Europe.
- MeSH
- Hepatectomy * methods standards MeSH
- Clinical Protocols MeSH
- Humans MeSH
- Liver Neoplasms surgery MeSH
- Perioperative Care * methods standards MeSH
- Postoperative Complications prevention & control MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Geographicals
- Europe MeSH
Second edition 2 svazky v 1 (ix, 56 stran a viii, 47 stran) ; 30 cm
- MeSH
- Organization and Administration standards MeSH
- Fraud prevention & control MeSH
- Social Control Policies standards MeSH
- Publication type
- Guideline MeSH
- Conspectus
- Metrologie. Standardizace
- NML Fields
- sociologie
Arrested or protracted labor in nulliparous women caused by insufficient uterine contractility is a common problem in obstetrics, for which few management guidelines exist. The European Association of Perinatal Medicine nominated an expert panel, consisting of specialists in obstetrics and gynecology and midwives representing their respective professional national societies in nine European countries and patient representatives. The panel developed an evidence-based guideline for clinical practice supported by the Knowledge Institute of the Dutch Association of Medical Specialists. Five priority clinical questions (PICOs) were identified on nulliparous women, at term, with a singleton fetus, in cephalic presentation, and the diagnosis of arrested or protracted labor. For each question relevant outcome measures were defined as well as a minimal clinically important difference for each of them. Five literature searches were performed by an information specialist and articles were selected independently by two panel members. The GRADE methodology was used to write evidence summaries, considerations, and recommendations. The draft guideline was sent out for review to scientific societies involved in perinatal care in 20 European countries. Comments were answered, and the guideline was revised accordingly. The following procedures should be offered to women: 1) Amniotomy alone may be considered. 2) Women should be informed that there is no scientific evidence regarding the beneficial effects of immediate (<1 h) or delayed administration of oxytocin, although the first option may reduce the duration of labor. A joint decision is recommended, based on clinical judgment, and women's values and preferences. 3) A low-dose oxytocin regimen for labor augmentation should be considered. 4) Amniotomy should be considered before the administration of oxytocin infusion during the first stage of spontaneous labor. 5) Oxytocin augmentation for at least four hours with adequate uterine contractions should be considered, before an operative delivery is proposed, provided that fetal and maternal conditions are adequate.
- MeSH
- Amniotomy MeSH
- Dystocia * therapy diagnosis MeSH
- Obstetric Labor Complications * therapy diagnosis MeSH
- Humans MeSH
- Oxytocin administration & dosage MeSH
- Parity MeSH
- Labor, Obstetric MeSH
- Pregnancy MeSH
- Oxytocics administration & dosage MeSH
- Delivery, Obstetric MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Practice Guideline MeSH
- Geographicals
- Europe MeSH
PURPOSE: Off-label drugs are being used in laryngology. Prescribing of a medicinal product is a decision taken within the relationship between a patient and his/her treating health care provider (HCP). The purpose of this article is to discuss the medicolegal aspects of off-label drug use, to provide recommendations for obtaining informed patient consent for off-label treatment and to propose the place and role of scientific societies and specialist boards in shaping good practices in this area. The final aim is to present recommendations concerning off-label usage and propose special clauses in informed patients consent. METHODS: The literature was reviewed regarding off-label applications in laryngology. Practical information on off-label use in various EU countries was collected. RESULTS: Registration data and pharmacokinetics of cidofovir, bevacizumab, Gardasil®, hyaluronic acid and mitomycin are provided. Off-label prescribing is not prohibited by EU law. Informed consent to treatment with an off-label drug exists in all EU countries. The risk that a court will accept liability of a HCP in case of off-label prescribing is higher than in case of on-label prescribing. If a HCP is held liable for the outcome of a medical treatment, the approval by the competent authorities and professional guideline is a strong defense. CONCLUSION: A patient's precise, explicit consent for the procedures including off-label drugs administration is mandatory. The second prerequisite is defining a need for creating based on recommendations by national or international scientific societies.
- MeSH
- Informed Consent * legislation & jurisprudence MeSH
- Humans MeSH
- Off-Label Use * legislation & jurisprudence MeSH
- Otolaryngology * legislation & jurisprudence MeSH
- Societies, Medical MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Consensus Development Conference MeSH
- Geographicals
- Europe MeSH
BACKGROUND: Liver glycogen storage disorders (GSDs) are rare inherited disorders of carbohydrate metabolism that are clinically characterized by hepatomegaly and fasting intolerance. This group of disorders comprises GSD Ia and Ib as well as the so-called ketotic GSDs including GSD III, VI, IX, XI and 0a. Although clinical practice guidelines exist for most GSD subtypes, diagnostics, treatment and monitoring differ significantly among metabolic centres. The aim of this study was to gain insight into current clinical practice for liver GSDs. METHODS: An international web-based survey was performed among health care professionals involved in the care of individuals with liver GSDs. RESULTS: Sixty-seven respondents from 28 different countries caring for approximately 2650 liver GSD patients completed the survey. While the diagnostic approach was generally consistent, significant differences among metabolic centres are still observed with respect to monitoring parameters and treatment approaches. Reasons for these differences are local availability of management tools and treatment options, the rarity of the different GSD subtypes, the experiences of health care professionals, and the existence of extreme phenotypes. CONCLUSION: The development of a standard set of outcomes for patients with liver GSDs is warranted as a reference for both daily care and the evaluation of safety and efficacy of future therapies. For various parameters that serve as valuable outcome measures, tools and target values should be better defined.
- MeSH
- Glycogen Storage Disease * therapy diagnosis MeSH
- Liver metabolism pathology MeSH
- Humans MeSH
- Disease Management MeSH
- Liver Diseases * therapy diagnosis MeSH
- Surveys and Questionnaires MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
