BACKGROUND: The contemporary management of ambulatory ulcerative colitis (UC) continues to be challenging with ∼20% of children needing a colectomy within childhood years. We thus aimed to standardize daily treatment of pediatric UC and inflammatory bowel diseases (IBD)-unclassified through detailed recommendations and practice points. METHODS: These guidelines are a joint effort of the European Crohn's and Colitis Organization (ECCO) and the Paediatric IBD Porto group of European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). An extensive literature search with subsequent evidence appraisal using robust methodology was performed before 2 face-to-face meetings. All 40 included recommendations and 86 practice points were endorsed by 43 experts in Paediatric IBD with at least an 88% consensus rate. RESULTS: These guidelines discuss how to optimize the use of mesalamine (including topical), systemic and locally active steroids, thiopurines and, for more severe disease, biologics. The use of other emerging therapies and the role of surgery are also covered. Algorithms are provided to aid therapeutic decision-making based on clinical assessment and the Paediatric UC Activity Index (PUCAI). Advice on contemporary therapeutic targets incorporating the use of calprotectin and the role of therapeutic drug monitoring are presented, as well as other management considerations around pouchitis, extraintestinal manifestations, nutrition, growth, psychology, and transition. A brief section on disease classification using the PIBD-classes criteria and IBD-unclassified is also part of these guidelines. CONCLUSIONS: These guidelines provide a guide to clinicians managing children with UC and IBD-unclassified management to provide modern management strategies while maintaining vigilance around appropriate outcomes and safety issues.
- MeSH
- ambulantní péče normy MeSH
- dítě MeSH
- fyziologie výživy dětí MeSH
- lidé MeSH
- společnosti lékařské MeSH
- ulcerózní kolitida diagnóza terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- konsensus - konference MeSH
- směrnice pro lékařskou praxi MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. RESULTS: As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). CONCLUSIONS: Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.
- Klíčová slova
- Anticoagulant therapy, Deep venous thrombosis, Home, Hospital, Outcome,
- MeSH
- ambulantní péče normy statistika a číselné údaje MeSH
- antikoagulancia terapeutické užití MeSH
- dolní končetina krevní zásobení MeSH
- dospělí MeSH
- hodnocení rizik metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- pacienti ambulantní statistika a číselné údaje MeSH
- prognóza MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- žilní trombóza komplikace diagnóza terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- antikoagulancia MeSH
AIMS: The objective of this study was to assess diabetes care in outpatient diabetes clinics in the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia. METHODS: Questionnaires for each randomly enrolled patient were completed by an endocrinologist or diabetologist. Data concerning age, sex, diabetes duration, diabetes type, treatment type, glycated haemoglobin (HbA(1c)), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C), blood pressure (BP) and short- and long-term diabetes complications were recorded. Questionnaires were analysed centrally for each country and stratified for Type 1 diabetes (T1D), Type 2 diabetes (T2D) and other types of diabetes. RESULTS: Data on 10 950 individuals were analysed (mean population age 56.2 years; females 52%; T1D 22.9%; T2D 75.3%; mean time from diagnosis 11 years). Patients with HbA(1c) within target (< 6.5%): T1D 13.1%, T2D 21.4%; for TC levels (< 4.5 mmol/l): T1D 37%, T2D 20%; for TG levels (< 1.7 mmol/l): T1D 78%, T2D 44%; for HDL-C (> 1.1 mmol/l): T1D 81%, T2D 60%; for LDL-C (< 2.5 mmol/l): T1D 36%, T2D 23%; for BP (< 130/80 mm Hg): T1D 42%, T2D 9%. The prevalence of severe hypoglycaemia (within the last 6 months) was 12% in T1D and 2% in T2D. Prevalence of diabetic ketoacidosis was 0.3-6.6%, blindness 0.15-1.3% and diabetic nephropathy 19-42%. CONCLUSIONS: The data show the current quality of care and potential areas for improvement. The quality of care is generally comparable with that in Western Europe.
- MeSH
- ambulantní péče normy MeSH
- biologické markery krev MeSH
- diabetes mellitus 1. typu terapie MeSH
- diabetes mellitus 2. typu terapie MeSH
- diabetes mellitus terapie MeSH
- diabetická retinopatie terapie MeSH
- diabetické nefropatie terapie MeSH
- dospělí MeSH
- glykovaný hemoglobin analýza MeSH
- lidé středního věku MeSH
- lidé MeSH
- průřezové studie MeSH
- průzkumy zdravotní péče MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- východní Evropa MeSH
- Názvy látek
- biologické markery MeSH
- glykovaný hemoglobin MeSH
Between April 24 and September 18, 2003, a total of 7,099 outpatient treatments were performed. Between June 3 and September 18, 2003, a total of 124 patients were surgically treated and 209 patients were hospitalized; the hospital recorded 1,239 bed-days, 137 of them in the intensive care unit. A total of 924 X-ray and ultrasound examinations were performed, as well as 10,014 laboratory tests. Local inhabitants accounted for 90.5% of the patients. In their practice, the doctors encountered a very wide spectrum of surgical and nonsurgical diagnoses. Part of the work was to support humanitarian activities, with supplies of humanitarian material, selection of children for specialized cardiosurgical treatment in the Czech Republic, and blood donations. Work in that unstable region was significantly complicated by the extreme climate and the high security risk.
- MeSH
- altruismus MeSH
- ambulantní péče normy statistika a číselné údaje MeSH
- lidé MeSH
- péče o pacienta * MeSH
- vedení války MeSH
- veřejné zdravotnictví - praxe MeSH
- vojenské lékařství normy statistika a číselné údaje MeSH
- vojenské nemocnice * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Irák MeSH
- MeSH
- ambulantní péče normy MeSH
- lidé MeSH
- obory ošetřovatelské * MeSH
- odborné všeobecné sestry * MeSH
- prenatální péče normy MeSH
- těhotenství MeSH
- veřejné zdravotnické služby MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Československo MeSH
