Distress management in cancer patients: Guideline adaption based on CAN-IMPLEMENT.

OBJECTIVE: This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource (CAN-IMPLEMENT), and develop Cancer-related Distress Management Guidelines in the context of the research site. METHODS: According to CAN-IMPLEMENT, the symptoms of cancer patients in Shanghai were investigated, and a work plan was formulated to adapt cancer-related distress management guidelines. The relevant clinical practice guidelines for distress management in cancer patients were searched, screened and assessed, the contents of the included clinical practice guidelines were screened, extracted and integrated, and the Cancer-related Distress Management Guidelines was developed. After peer review, the Cancer-related Distress Management Guidelines was finally formed. RESULTS: The physical symptom distress score was higher than the psychological symptom distress score among cancer patients in Shanghai. Two clinical practice guidelines related to distress management in cancer patients were included after searching, screening, assessment and selection systematically. The domain scores of the draft Cancer-related Distress Management Guidelines on Appraisal of Guidelines for Research and Evaluation II (AGREE II) were 73.75%-87.50%, respectively. The scores of most recommendations on feasibility, appropriateness, meaningfulness and effectiveness were at least 90%. The final guidelines included 13 recommendations. CONCLUSIONS: The quality of the draft Cancer-related Distress Management Guidelines based on two included guidelines was well-accepted. The final Cancer-related Distress Management Guidelines needs to be further verified in clinical practice for feasibility, suitability and effectiveness.

"Best practices of occupational therapy in schools" - uma resenha crítica e aportes para terapeutas ocupacionais no setor da educação / "Best practices of occupational therapy in schools" - a critical review and contributions for occupational therapists in the education sector

Resumo O presente texto é resultado de um seminário do Grupo de Pesquisa "Cidadania, Ação Social, Educação e Terapia Ocupacional", ocorrido em 2019, entre os integrantes da linha "Escola, Terapia Ocupacional e Inclusão Radical", que se debruçaram sobre o livro "Best practices of Occupational Therapy in Schools". Editado em 2013, esse livro teve grande circulação nos Estados Unidos da América, compondo parte dos esforços da American Occupational Therapy Association para ofertar e ampliar subsídios teórico-práticos que garantissem tanto a inserção como a qualificação da atuação dos terapeutas ocupacionais em serviços e ações junto ao setor da educação. Consideramos que compartilhar uma síntese desse material, bem como as reflexões críticas que foram fomentadas pelo seu estudo, em diálogo contextualizado no cenário brasileiro, possa inspirar novas proposições para terapeutas ocupacionais que têm se dedicado a esse setor, mas também colocar em debate os riscos que transposições lineares podem causar, uma vez que determinados modelos e abordagens respondem a contextos situados, histórica e politicamente. Explicitadas nossas diferenças, que a circulação das propostas desse livro possa, sobretudo, contribuir para alavancar novas e eficientes estratégias para ampliarmos o número de profissionais envolvidos com o setor da educação.

Abstract This text is the result of a seminar by the Research Group "Citizenship, Social Action, Education and Occupational Therapy", which took place in 2019, among the members of the "School, Occupational Therapy and Radical Inclusion" line, who have investigated the book "Best Practices of Occupational Therapy in Schools". Published in 2013, this book was widely read in the United States of America, as part of the efforts of the American Occupational Therapy Association to offer and expand theoretical and practical subsidies that would guarantee both the insertion and the qualification of performance of the occupational therapists in services and actions tied to the education sector. We believe that sharing a synthesis of this material, as well as critical reflections that were fostered by your study, in a contextualized dialogue in the Brazilian scenario, may inspire new proposals for occupational therapists who have dedicated themselves to this sector, but also discuss the risks that model transpositions can cause, since certain models and approaches respond to historically and politically situated contexts. With our differences explained, we wish that the circulation of the proposals in this book may, above all, contribute to leverage new and efficient strategies to expand the number of professionals involved in the education sector.

Updated key points of the 2019 EASL guidelines for drug-induced liver injury and its practice in China / 临床肝胆病杂志

To further understand the 2019 EASL Guidelines for drug-induced liver injury (DILI), this article outlined the updated key points of the guidelines and analyzed these points with reference to the reality of China, including the type of DILI, DILI induced by herbs and dietary supplements, prospective versus retrospective studies, diagnosis and causality assessment, risk factors, special phenotypes of DILI, management of DILI induced by immune checkpoint inhibitors, indication for the withdrawal of antitubercular agents, new biomarkers for DILI under clinical research, and therapeutic drugs for DILI. It is pointed out that the new version of the EASL guidelines redefined the diagnosis of acute and chronic DILI, provided detailed management strategies for DILI induced by immune checkpoint inhibitors and criteria for the withdrawal of antitubercular agents, and summarized several special phenotypes of DILI, with an emphasis on DILI induced by herbs and dietary supplements. Therefore, these guidelines have a good reference value for the diagnosis and treatment of DILI in China.

Otolaryngologists adhere to evidence-based guidelines for chronic rhinosinusitis.

PURPOSE: To assess awareness of, opinion about and adherence to evidence-based guidelines on chronic rhinosinusitis among Dutch Otolaryngologists. METHODS: We assessed implementation of two guidelines, one Dutch and one European, that are both intended for diagnosis and treatment of patients with chronic rhinosinusitis. We invited 485 Otolaryngologists to fill out a questionnaire and report on their opinion on and adherence to the guidelines. The adherence was further tested by 4 clinical case scenarios, derived from guideline recommendations. RESULTS: 166 (34%) completed the questionnaire. 99% of the respondents was aware of one or both guidelines. Most respondents (90%) consider the guidelines as directing or supportive for their clinical practice based on the clinical case scenarios, between 62 and 99% of the respondents act according to guidelines. Concerning diagnosis, CT-imaging is performed more and allergy testing less than recommended. Where multiple treatment options are recommended, the responses are more heterogeneous as a result of this. Nonetheless, high recommended treatment was chosen more often. Otolaryngologists were reluctant in surgical treatment as a first option, which is according to the guidelines. CONCLUSIONS: Overall, both the EPOS and CBO guideline are well known among Dutch Otolaryngologists and 90% indicates that the guideline is important in their daily practice. Adherence to the guidelines is sufficient to high. If multiple treatment or diagnostic options are recommended this leads to a more heterogeneous response pattern. Recommendations with a high grade of recommendation were followed up most often.

Caracterização imuno-histoquímica e molecular dos pacientes com suspeita clínica de Síndrome de Lynch / Immunohistochemical and molecular characterization of patients with clinical suspicion of Lynch Syndrome

Suspeita-se da Síndrome de Lynch (SL) a partir da história pessoal e familial do indivíduo. Posteriormente, os dados histopatológicos, imuno-histoquímicos e moleculares podem ser utilizados para aprimorar o diagnóstico da doença. Entretanto, um grande desafio no diagnóstico da Síndrome de Lynch é a baixa acurácia dos critérios clínicos utilizados. OBJETIVOS: Avaliar a frequência de SL em pacientes submetidos a tratamento cirúrgico por câncer colorretal e com história familial de câncer. Avaliar quais dos critérios clínicos e/ou moleculares seriam mais informativos no diagnóstico desta Síndrome na população brasileira. PACIENTES E MÉTODOS: Estudaram-se 458 casos de câncer colorretal (CCR), do Serviço de Coloproctologia do Departamento de Gastroenterologia do Hospital das Clínicas - FMUSP, de janeiro de 2005 a dezembro de 2008. História familial (HF) positiva para CCR ocorreu em 118 pacientes. Promoveu-se a revisão das lâminas para critérios histopatológicos de MSI (diretrizes de Bethesda), avaliação imuno-histoquímica (IHC) para as proteínas MLH1, MSH2, MSH6, PMS2, através do complexo avidina-biotina-peroxidase e instabilidade de microssatélites (MSI) (BAT-25, BAT-26, NR-21, NR-24 e MONO-27). Realizada a análise da mutação somática para o BRAF em todos os casos com MSI positiva. RESULTADOS: Dos 118 pacientes com HF, 61 (51,69%) preencheram pelo menos um dos critérios de Bethesda revisados. 36 eram do sexo feminino (59%), média de idade de 53,2 anos. Nove (14,7%) pacientes apresentaram todos os critérios de Amsterdam I. Cinquenta e dois tumores localizaram-se no cólon esquerdo. Os componentes histopatológicos de MSI incluíram: linfócitos intratumoral (47,5%), característica expansiva do tumor (29,5%) e o componente mucinoso (27,8%) (componentes histopatológicos de MSI instável) em 44 (72%). A IHC estava alterada em oito (13%) e a MSI em 12 pacientes (20%). Houve associação entre os critérios de Amsterdam I e MSI e na IHC com MLH1 e PMS2. Houve associação entre...

Lynch Syndrome is suspected due to the personal and familial history of the individual. Subsequently, histopathological, immunohistochemical and molecular data can be used to improve diagnosis of the disease. However, a major challenge in the diagnosis of Lynch Syndrome is the low accuracy of clinical criteria. OBJECTIVES: To assess the frequency of Lynch Syndrome in patients with familial cancer history submitted to colorectal cancer resection. To assess what clinical and / or molecular criteria would be the most informative in the diagnosis of this syndrome in Brazilian population. PATIENTS AND METHODS: 458 colorectal cancer (CRC) cases were studied, from the Coloproctology Unit of the Department of Gastroenterology, Hospital das Clinicas - USP, from January 2005 to December 2008. Positive family history (FH) for CRC occurred in 118 patients. The pathologic slides were reviewed for histological criteria for MSI (Bethesda guidelines), immunohistochemical analysis (IHC) for MLH1, MSH2, MSH6, PMS2 proteins, through the avidin-biotin-peroxidase complex, and microsatellite instability (MSI) (BAT-25, BAT-26, NR-21, NR-24 and MONO-27). BRAF somatic mutation was analyzed in all cases with positive MSI. RESULTS: Of the 118 patients with HF, 61 (51.69%) met at least one of the revised Bethesda criteria. Thirty-six were female (59%), and the mean age was 53.2 years. Nine (14.7%) patients presented all Amsterdam criteria I. Fifty-two tumors were located in the left colon. MSI histopathological components included: intratumoral lymphocytes (47.5%), expansive characteristics of the tumor (29.5%) and mucinous component (27.8%) (Histological unstable components of MSI) in 44 (72%). IHC was abnormal in eight (13%) and MSI in 12 patients (20%). There was an association between the Amsterdam criteria I and MSI; and between IHC with MLH1 and PMS2. There was an association with the revised Bethesda criteria with: sex, mucinous histology and Crohn's like...

Updated key points of the 2019 EASL guidelines for drug-induced liver injury and its practice in China / 临床肝胆病杂志

To further understand the 2019 EASL Guidelines for drug-induced liver injury (DILI), this article outlined the updated key points of the guidelines and analyzed these points with reference to the reality of China, including the type of DILI, DILI induced by herbs and dietary supplements, prospective versus retrospective studies, diagnosis and causality assessment, risk factors, special phenotypes of DILI, management of DILI induced by immune checkpoint inhibitors, indication for the withdrawal of antitubercular agents, new biomarkers for DILI under clinical research, and therapeutic drugs for DILI. It is pointed out that the new version of the EASL guidelines redefined the diagnosis of acute and chronic DILI, provided detailed management strategies for DILI induced by immune checkpoint inhibitors and criteria for the withdrawal of antitubercular agents, and summarized several special phenotypes of DILI, with an emphasis on DILI induced by herbs and dietary supplements. Therefore, these guidelines have a good reference value for the diagnosis and treatment of DILI in China.