Search results

1

Updated National Comprehensive Cancer Network guidelines for treatment of head and neck cancers 2010-2017

100%

Wierzbicka M., Napierała J.

Otolaryngologia Polska

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2017

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vol. 71(6)

1-6

EN

Introduction: The diagnostic and therapeutic recommendations have been changing over the years to improve treatment outcomes and quality of life of Head and Neck Cancer (HNC) patients. Aim: The aim of this study was to present currently recommended Head and Neck Cancer treatment guidelines based on the literature review with particular emphasis on novel approaches the NCCN algorithms. Material and methods: The review of literature covering articles published in the last five years and pointing out essential changes in HNC treatment regarding evidence based medicine. The study focused on the analysis of novel approaches for the particular primaries, the implementation of biological therapies and personalized cancer therapies. Results: Updates in the oncological NCCN guidelines for all ENT primaries except major salivary glands and subglottis are based on knowledge derived from the basic sciences, clinical trials and the best evidence available currently. The latest recommendations emphasize value of biological therapies use.

2

Recommendations for the standards of equipping of the Bariatric and Metabolic Surgery Center

100%

Sztuczka E., Żukowska W., Jackowski M., Janik M. R., Paśnik K., Michalik M.

Polish Journal of Surgery

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2018

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vol. 90(5)

52-56

EN

Introduction: The prevalence of obesity in Poland and worldwide is constantly rising. High effectiveness of bariatric surgery has been proven in literature. It is recommended that bariatric procedures should be done by highly qualified surgeons with the appropriate, up-to-date medical equipment. Aim: The purpose of the study is to establish Polish recommendations and standards for the use of medical equipment for bariatric surgery centers. Materials and methods: The review of the present recommendations of the worldwide organizations and societies (including EAES, IFSO, SAGES) and guidelines was made. On the basis of current literature and authors’s clinical experience we proposed standardized protocol for bariatric surgical equipment. Conclusions: Relevant equipping of bariatric surgery centers and implementation of standardized perioperative and surgery protocols will result in significant improvements in bariatric treatment. This will ensure patients safety, a shorter length of hospital stay and considerably reduce the risk of morbidity. Moreover, it will contribute to the efficacy of the bariatric and metabolic surgery procedures, in accordance with the highest globally accepted standards.

3

Comments for “Recommendations for fetal echocardiography in singleton pregnancy in 2015”

100%

Szymkiewicz - Dangel J., Brzezińska - Rajszys G., Maruszewski B., Włoch A.

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2015

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vol. 5

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issue 4

36-39

4

Do we need changes in the organization of training in the hernia treatment in Poland? A survey on the acknowledgment of the recommendations of international hernia societies by surgeons

100%

Mitura K., Dąbrowiecki S., Śmietański M., Matyja A.

Polish Journal of Surgery

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2017

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vol. 89(5)

12-18

EN

In the therapy of an inguinal hernia, there is a huge variety in the way of treating and the choice of surgical technique. Practice shows that the intraoperative improvisation and surgeons’ own modifications of the original techniques have become part of routine procedure. No mandatory hernia registration system causes the actual detailed herniology status in our country remains unknown. The aim of the study was to summarize the results of a survey on knowledge of a hernia according to the standards developed by international hernia societies compared with everyday clinical practice. During the International Conference Hernia in Poland, which took place on 10 December 2016 in Zakopane we conducted an interactive session among 106 surgeons dealing with hernias. Surgeons responded to 66 questions about daily surgical practice and decision making in their centers, and 27 questions for the assessment of the world’s latest treatment recommendations regarding groin hernias. The most common method of using the implant technique Lichtenstein, used by 91% of doctors. 20% of surgeons in planned operations in adult men routinely uses no mesh technique. Almost 80% of respondents do not apply TEP or TAPP. Only 45.7% of surgeons customize surgical technique to the patient. Only 7 of the 27 analyzed recommendation has been accepted by more than 90% of respondents. 9 of the 27 recommendations were approved by less than half of the surgeons. In the case of 11 recommendations, surgeons simultaneously failed to comply with these recommendations in daily practice. Deficiencies in the system of training and the underfunding of medical procedures cause insufficient TAPP/ TEP availability in Poland in an inguinal hernia. Improvement of the surgeons’ knowledge on how to perform surgery

5

Principles of follow-up assessments in patients with breast cancer after radical treatment

100%

Hodorowicz-Zaniewska D., Herman K.

Polish Journal of Surgery

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2017

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vol. 89(3)

36-39

EN

A follow-up assessment plan after radical treatment is a part of a comprehensive approach to treating patients with breast cancer. Because breast cancer is the most frequent cancer both worldwide and in Poland, adequate follow-up is important not only for patients but also for economic reasons. Herein, we review current recommendations for follow-up assessments in patients with breast cancer. The main aim of such assessment is detection of early recurrence or tumor presence in the other breast, observation of long-term treatment complications, and creation of multidisciplinary infrastructure that will allow to reduce the risk of recurrence and alleviate physical, mental, and social consequences of treatment.

6

The Evolution of Physical Activity Guidelines

100%

Piątkowska M., Ružbarská I.

Baltic Journal of Health and Physical Activity

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2011

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vol. 3

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issue 4

299-310

EN

Background: As the scientific support for the impact of physical activity on health has grown, physical activity recommendations for the public have been modified. The aim of the paper is to present the evolution of physical activity guidelines, which were formulated on the basis of existing research evidence, produced by experts, mainly in physiology and medicine.Material/Methods: A systematic literature review was applied. In order to interpret the content of text data, a qualitative content analysis was used. It was supported by the Qualitative Data Analysis (QDA) computer software package NVivo 9.Results: Recognition of hazards of a sedentary lifestyle has led numerous groups to promulgate public health recommendations for physical activity. Since 1950s leading scientists and science organisations have participated in developing and publicising these guidelines and in revising them to keep up with the pace of modern exercise science. The paper discusses reasons for differences in the guidelines and provides a summary in order to harmonize existing reports.Conclusions: Using epidemiological, clinical and laboratory methods, different expert committees have independently arrived at similar conclusions about the need for physical activity in daily life. However, formulating guidelines regarding an optimal dose of physical activity, which could be universal for everybody, is very problematic. A recommended dose of physical activity must be approachable and adjusted to a particular person or a group.

7

Updated National Comprehensive Cancer Network guidelines for treatment of head and neck cancers 2010-2017

100%

Wierzbicka M., Napierała J.

Polish Journal of Otolaryngology

|

2017

|

vol. 71

|

issue 6

1-6

EN

Introduction: The diagnostic and therapeutic recommendations have been changing over the years to improve treatment outcomes and quality of life of Head and Neck Cancer (HNC) patients. Aim: The aim of this study was to present currently recommended Head and Neck Cancer treatment guidelines based on the literature review with particular emphasis on novel approaches the NCCN algorithms. Material and methods: The review of literature covering articles published in the last five years and pointing out essential changes in HNC treatment regarding evidence based medicine. The study focused on the analysis of novel approaches for the particular primaries, the implementation of biological therapies and personalized cancer therapies. Results: Updates in the oncological NCCN guidelines for all ENT primaries except major salivary glands and subglottis are based on knowledge derived from the basic sciences, clinical trials and the best evidence available currently. The latest recommendations emphasize value of biological therapies use.

8

Translational medical research in Nigeria: challenges, prospects and recommendations for the future

88%

Salami A., Kanmodi K. K.

European Journal of Translational and Clinical Medicine

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2021

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vol. 4

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issue 1

71-78

EN

In this review we discussed the challenges and prospects for translational medical research in Nigeria, a developing African country. We also provided some relevant recommendations on how to improve the future of translational medical research in the Nigeria.

9

The Role of Administrative Decisions in the Development of Metropolitan Areas

88%

Nowak M. J., Nowak M. J.

Studia KPZK

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2018

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vol. 186

10

Physiotherapy in the treatment of idiopathic scoliosis - current recommendations based on the recommendations of SOSORT 2011 (Society on Scoliosis Orthopaedic and Rehabilitation Treatment)

75%

Czaprowski D., Kotwicki T., Durmała J., Stoliński Ł.

Advances in Rehabilitation

|

2014

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vol. 28

|

issue 1

23-29

EN

SOSORT to międzynarodowe towarzystwo naukowe zajmujące się deformacjami kręgosłupa, w tym skoliozą idiopatyczną (SI). Jednym z podstawowych zadań towarzystwa jest dostarczanie wszystkim profesjonalistom zaangażowanym w zachowawcze leczenie chorych z SI rekomendacji diagnostyczno-terapeutycznych. W ramach leczenia skolioz wyróżnia się leczenie zachowawcze oraz leczenie operacyjne. Podstawowym celem leczenia zachowawczego jest zatrzymanie progresji skrzywienia. Celem terapii są również poprawa jakości życia, estetyki oraz wydolności fizycznej. Istotnym elementem leczenia zachowawczego jest fizjoterapia, która może być stosowana jako samodzielny środek leczniczy, a także jako wspomaganie leczenia gorsetowego i operacyjnego. SOSORT rekomenduje stosowanie fizjoterapii w postaci specyficznej fizjoterapii ambulatoryjnej (PSE) oraz stacjonarnej intensywnej rehabilitacji (SIR). PSE stosowana u chorych z SI musi mieć potwierdzoną zgodnie z wymogami Medycyny Opartej na Dowodach Naukowych skuteczność. Ponadto terapia powinna być dobierana indywidualnie i obejmować: (1) trójpłaszczyznową autokorekcję deformacji, (2) trening w czynnościach dnia codziennego, (3) stabilizację skorygowanej postawy ciała oraz (4) edukację chorego i jego rodziców. SIR polegająca na 3-4 tygodniowych pobytach dziecka w warunkach szpitalnych lub sanatoryjnych rekomendowana jest przede wszystkim w początkowym okresie leczenia. Fizjoterapeuta podejmujący się pracy z dziećmi z SI powinien: (1) posiadać kwalifikacje w posługiwaniu się PSE, (2) mieć odpowiednie doświadczenie w fizjoterapii w ortopedii dziecięcej, (3) posiadać umiejętność analizy zmienności postawy ciała w ontogenezie, (4) posiadać umiejętność doboru ćwiczeń w zależności od etapów kształtowania się cech motorycznych oraz (5) pracować w zespole terapeutycznym, któremu przewodzi lekarz nadzorujący proces leczenia.

11

Postoperative pain relief in general surgery – recommendations of the Association of Polish Surgeons, Polish Society of Anaesthesiology and Intensive Therapy, Polish Association for the Study of Pain and Polish Association of Regional Anaesthesia and Pain Treatment

75%

Wordliczek J., Zajączkowska R., Dziki A., Jackowski M., Richter P., Woroń J., Misiołek H., Dobrogowski J., Paśnik K., Wallner G., Malec-Milewska M.

Polish Journal of Surgery

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2019

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vol. 91(1)

47-68

EN

It is estimated that there are over 310 million surgeries performed in the world every year. Appropriate analgesic management in the perioperative period constitutes a fundamental right of every patient, significantly reducing the number of postoperative complications and the time and costs of hospitalization, particularly in the high-risk group of patients (ASA III-V) subject to extensive surgical procedures and hospitalized in intensive care units. Despite such significant arguments speaking for the conduct of effective analgesia in the perioperative period, nearly 79% of patients operated in hospitalization settings and 71% of patients operated in outpatient settings (so-called first day surgery) experienced postoperative pain of moderate, strong or extreme intensity. Hence, effective relief of postoperative pain should constitute one of the priorities of integrated, modern perioperative management, the components of which apart from adequate analgesia involve early nutrition through the alimentary canal, early patient activation and active physiotherapy. In the currently published “Guidelines”, a team of authors has updated the previous “Recommendations” primarily in terms of methods for optimizing postoperative pain relief and new techniques and drugs introduced for postoperative pain therapy in recent years. The algorithms of postoperative pain management in different treatment categories were also updated.

12

Zasady stosowania dootrzewnowej chemioterapii w hipertermii (HIPEC) w leczeniu nowotworów złośliwych powierzchni otrzewnej w połączeniu z zabiegami cytoredukcyjnymi: zalecenia krajowe

63%

Rutkowski P., Śpiewankiewicz B., Herman K., Jastrzębski T., Kładny J., Kojs Z., Krzakowski M., Polkowski W., Wyrwicz L., Wysocki P., Zdzienicki M., Zegarski W.

Current Gynecologic Oncology

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2014

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vol. 12

|

issue 2

86-97

EN

The management of peritoneal surface malignancy is a significant clinical problem in oncology. It was demonstrated that the combination of complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) may lead to long-term control of the disease or improved survival in selected patients. The aim of this paper was to present the optimal indications and technical guidelines for performing HIPEC in Poland. The application of this method requires experience of a multidisciplinary team of physicians (gynecologic oncologist, surgeon and clinical oncologist), availability of diagnostic and therapeutic resources (intensive care unit) as well as a dedicated perfusion system. A crucial aspect for obtaining optimal treatment outcomes is the selection of patients. Such a selection takes place both at the beginning of treatment and intraoperatively. The initial selection of patients qualified for HIPEC includes ruling out extraperitoneal spread of cancer and metastases to the liver (single resectable liver metastases in patients with colorectal carcinoma are not contraindications) and lungs. According to current international guidelines, the HIPEC procedure is a standard treatment in patients with ovarian carcinoma that metastasizes to the peritoneum, in colorectal cancer, when PCI <20 and in patients with peritoneal mesothelioma or pseudomyxoma peritonei as well as in patients with gastric cancer.

PL

Leczenie nowotworów złośliwych powierzchni otrzewnej stanowi istotny problem w onkologii. Wykazano, że skojarzenie maksymalnej cytoredukcji chirurgicznej z dootrzewnową chemioterapią w hipertermii (hyperthermic intraperitoneal chemotherapy, HIPEC) może prowadzić do długotrwałej kontroli choroby lub wydłużenia przeżyć u odpowiednio wybranych chorych. Celem niniejszego opracowania są zalecenia dla optymalnego zakresu wskazań i sposobu prowadzenia HIPEC w Polsce. Zastosowanie tej metody wymaga doświadczenia wielospecjalistycznego zespołu lekarskiego (ginekolog onkolog, chirurg, onkolog kliniczny), a także zaplecza diagnostycznego i leczniczego (oddziału intensywnej opieki medycznej) oraz dedykowanego systemu do perfuzji. Kluczową kwestią dla uzyskania optymalnego wyniku leczenia jest odpowiedni dobór chorych. Dobór ten następuje zarówno na etapie planowania leczenia, jak i śródoperacyjnie. Wstępna selekcja pacjentów kwalifikowanych do leczenia z wykorzystaniem HIPEC obejmuje wykluczenie pozaotrzewnowych przerzutów nowotworu oraz przerzutów do wątroby (pojedyncze resekcyjne przerzuty do wątroby u chorych na raka jelita grubego nie są przeciwwskazaniem) i płuc. Zgodnie z istniejącymi zaleceniami międzynarodowymi procedura HIPEC jest standardowo stosowana u chorych z przerzutami do otrzewnej raka jajnika, raka jelita grubego, gdy PCI <20 oraz u chorych na międzybłoniaka lub śluzaka rzekomego otrzewnej i wybranych chorych na raka żołądka.

13

Pharmacotherapy of pain in cancer patients – recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons

63%

Wordliczek J., Kotlińska-Lemieszek A., Leppert W., Woroń J., Dobrogowski J., Krajnik M., Przeklasa-Muszyńska A., Jassem J., Drobnik J., Wrzosek A., Janecki M., Pyszkowska J., Kocot-Kępska M., Zajączkowska R., Filipczak-Bryniarska I., Boczar K., Jakowicka-Wordliczek J., Malec-Milewska M., Kübler A., Suchorzewski M., Mordarski S., Dziki A., Paśnik K.

Polish Journal of Surgery

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2018

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vol. 90(4)

55-84

EN

Guidelines for the pharmacotherapy of pain in cancer patients were developed by a group of 21 experts of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. During a series of meetings, the experts carried out an overview of the available literature on the treatment of pain in cancer patients, paying particular attention to systematic reviews and more recent randomized studies not included in the reviews. The search was performed in the EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials databases using such keywords as “pain”, “cancer”, “pharmacotherapy”, “analgesics”, and similar. The overviewed articles included studies of pathomechanisms of pain in cancer patients, methods for the assessment of pain in cancer patients, and drugs used in the pharmacotherapy of pain in cancer patients, including non-opioid analgesics (paracetamol, metamizole, non-steroidal anti-inflammatory drugs), opioids (strong and weak), coanalgesics (glucocorticosteroids, α2-adrenergic receptor agonists, NMDA receptor antagonists, antidepressants, anticonvulsants, topical medications) as well as drugs used to reduce the adverse effects of the analgesic treatment and symptoms other than pain in patients subjected to opioid treatment. The principles of opioid rotation and the management of patients with opioidophobia were discussed and recommendations for the management of opioid-induced hyperalgesia were presented. Drugs used in different types of pain experienced by cancer patients, including neuropathic pain, visceral pain, bone pain, and breakthrough pain, were included in the overview. Most common interactions of drugs used in the pharmacotherapy of pain in cancer patients as well as the principles for the management of crisis situations. In the final part of the recommendations, the issues of pain and care in dying patients are discussed. Recommendations are addressed to physicians of different specialties involved in the diagnostics and treatment of cancer in their daily practice. It is the hope of the experts who took part in the development of these recommendations that the recommendations would become helpful in everyday medical practice and thus contribute to the improvement in the quality of care and the efficacy of pain treatment in this group of patients.

14

Kluczowe problemy procesu leczenia raka błony śluzowej trzonu macicy w świetle wspólnych ustaleń ESMO, ESGO i ESTRO z grudnia 2015 roku

51%

Kryniewska K., Sznurkowski J. J.

Current Gynecologic Oncology

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2016

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vol. 14

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issue 3

145-155

EN

In December 2015, representatives of the European Society for Medical Oncology (ESMO), the European Society of Gynaecological Oncology (ESGO) and the European Society for Radiotherapy and Oncology (ESTRO) gathered to achieve a consensus on the current diagnostic methods as well as surgical and adjuvant treatment in endometrial cancer. During the conference, a multipage document identifying the key diagnostic and therapeutic problems, containing current findings together with the level of their scientific credibility was developed, followed by presenting expert consensus achieved by voting as well as a summary of evidence supporting each recommendation. The aim of the paper was to summarize the current ESMO, ESGO and ESTRO expert guidelines for a Polish reader in the absence of national recommendations on the diagnosis and treatment of endometrial cancer. The minimum (essential) preoperative management involves: clinical examination, including inguinal examination, speculum examination, bimanual examination, rectal examination, abdominal and transvaginal ultrasound, and, if indicated, transrectal ultrasound as well as risk assessment for Lynch syndrome if no ovariectomy is planned in FIGO stage I patients under the age of 45. A simple hysterectomy with the removal of the adnexa is the primary surgical protocol. Systematic lymphadenectomy involving pelvic and para-aortic lymph nodes should be performed in all patients (regardless of the histopathological type) with apparent FIGO stage IIIA, IIIB and FIGO stage II as well as in non-endometrioid apparent FIGO stage I cancers. In FIGO stage I endometrioid cancer, depending on the histopathological grade and the invasiveness, which is measured by myometrial invasion (MI), patients should be stratified into three preoperative risk groups: low risk – G1/G2 and MI < 50%, where systematic lymphadenectomy is not needed; intermediate risk – G1/G2, MI > 50% or G3, MI < 50%, where lymphadenectomy can be considered; high risk – G3 and MI > 50%, where lymphadenectomy is obligatory. The excision of the greater omentum should be performed only in serous cancer and carcinosarcoma. Stratification of patients for adjuvant treatment is based on pathological features, such as grading, MI, FIGO, lymphovascular space invasion. There is an urgent need to adapt the ESMO-ESGO-ESTRO consensus to Polish conditions as well as to develop national recommendations for the diagnosis and treatment of endometrial cancer.

PL

W grudniu 2015 roku przedstawiciele Europejskiego Towarzystwa Onkologii Klinicznej (European Society for Medical Oncology, ESMO), Europejskiego Towarzystwa Ginekologii Onkologicznej (European Society of Gynaecological Oncology, ESGO) oraz Europejskiego Towarzystwa Radioterapii i Onkologii (European Society for Radiotherapy and Oncology, ESTRO) zebrali się w celu opracowania wspólnego stanowiska dotyczącego aktualnych metod diagnostyki, leczenia operacyjnego i uzupełniającego raka błony śluzowej trzonu macicy. W trakcie konferencji powstał wielostronicowy dokument, w którym zidentyfikowano kluczowe problemy diagnostyczno-terapeutyczne, zamieszczono aktualne wyniki badań wraz z oceną poziomu ich wiarygodności naukowej, a następnie zaprezentowano ustalone w drodze głosowania wspólne stanowisko ekspertów z określeniem siły zaleceń i uzasadnieniem. Celem niniejszej pracy było syntetyczne przedstawienie aktualnych zaleceń ekspertów ESMO, ESGO i ESTRO polskiemu czytelnikowi w sytuacji braku krajowych rekomendacji dotyczących diagnostyki i leczenia raka błony śluzowej trzonu macicy. Minimalne (niezbędne) postępowanie przedoperacyjne obejmuje: badanie kliniczne, w tym ocenę pachwin, badanie we wziernikach, badanie dwuręczne, badanie per rectum, badanie ultrasonograficzne jamy brzusznej i przezpochwowe, a jeśli są wskazania – badanie ultrasonograficzne transrektalne, jak również ocenę ryzyka zespołu Lyncha, gdy nie planuje się usuwać jajników kobietom z FIGO I przed 45. rokiem życia. Podstawowy protokół operacyjny to proste wycięcie macicy wraz z przydatkami. Limfadenektomia systematyczna obejmująca węzły miedniczne i okołoaortalne powinna zostać wykonana u wszystkich pacjentek (niezależnie od typu histopatologicznego) z prawdopodobnym FIGO IIIA, IIIB i FIGO II oraz w rakach nieendometrioidalnych FIGO I. W raku endometrioidalnym FIGO I, w zależności od stopnia zróżnicowania histopatologicznego (gradingu) i inwazyjności nowotworu, mierzonej głębokością naciekania mięśniówki (myometrial invasion, MI), pacjentki podzielono na trzy przedoperacyjne grupy ryzyka: grupa o niskim ryzyku – G1/G2 i MI < 50%, w której można odstąpić od limfadenektomii systematycznej; grupa o pośrednim ryzyku – G1/G2, MI > 50% lub G3, MI < 50%, w której limfadenektomię można rozważyć; grupa wysokiego ryzyka – G3 i MI > 50%, w której limfadenektomia powinna być wykonywana obligatoryjnie. Wycięcie sieci większej należy wykonać wyłącznie w raku surowiczym i w mięsakoraku. Stratyfikacja chorych do leczenia adiuwantowego opiera się na cechach patologicznych, takich jak grading, MI, FIGO, inwazyjność przestrzeni limfatycznej. Adaptacja ustaleń konsensusu ESMO, ESGO i ESTRO do warunków polskich oraz stworzenie krajowych rekomendacji diagnostyki i leczenia raka endometrium jest pilną potrzebą.

15

Zmiany w zaleceniach Światowej Inicjatywy na Rzecz Zwalczania Astmy (GINA) 2019 – ważne modyfikacje sposobu leczenia

51%

Likońska A., Kowalski M. L., Chałubiński M.

|

EN

In this article there is included the summary of Global Initiative for Asthma recommendation (GINA), which is based on full report published in June 2019. It is considered that those changes are the most crucial ones since 30 years, because medication that has been recommended over 50 years inhaled short-acting β2-mimetic (SABA) is no longer advised as reliever. Now it is recommended to use budesonid and formoterol combined, which is inhaled glycokorticosteroid and long-acting β2-mimetic (LABA). In the following part changes in recommendations for sever asthma are described.

PL

W tym artykule jest zawarte podsumowanie zmian w zaleceniach Światowej Inicjatywy na Rzecz Zwalczania Astmy (GINA) opracowane na podstawie pełnego raportu, który został opublikowany w czerwcu 2019 roku. Uważa się, że zmiany te są najważniejszymi od 30 lat, ponieważ lek zalecany od ponad 50 lat, czyli krótko działający β2-mimetyk wziewny (SABA) nie jest już rekomendowany jako lek doraźny. Obecnie zalecane jest stosowanie połączenia budezonidu z formoterolem, czyli wziewnego glikokortykosteroidu z długo działającym β2-mimetykiem wziewnym. W dalszej części opisane są zmiany w zaleceniach w astmie ciężkiej.

16

Guidelines for the management of surgical departments in non-uniform hospitals during the COVID-19 pandemic

51%

Mitura K., Myśliwiec P., Rogula W., Solecki M., Furtak J. P., Kazanowski M., Kłęk S., Nowakowski M., Pędziwiatr M., Zawadzki M., Wallner G., Sobocki J.

Polish Journal of Surgery

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2020

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vol. 92(2)

42-53

EN

In the last several weeks we have been witnessing the exponentially progressing pandemic SARS-CoV-2 coronavirus. As the number of people infected with SARS-CoV2 escalates, the problem of surgical management of patients requiring urgent surgery is increasing. Patients infected with SARS-CoV2 virus but with negative test results will appear in general hospitals and may pose a risk to other patients and hospital staff. Health care workers constitutes nearly 17% of infected population in Poland, therefore early identification of infected people becomes a priority to protect human resources and to ensure continuity of the access to a surgical care. Both surgical operations, and endoscopic procedures are considered as interventions with an increased risk of infection. Therefore, determining the algorithm becomes crucial for qualifying patients for surgical treatment, but also to stratify the risk of personnel being infected during surgery and to adequately protect staff. Each hospital should be logistically prepared for the need to perform urgent surgery on a patient with suspected or confirmed infection, including personal protective equipment. Limited availability of the equipment, working under pressure and staff shortages in addition to a highly contagious pathogen necessitate a pragmatic management of human resources in health care. Instant synchronized action is needed, and clear uniform guidelines are essential for the healthcare system to provide citizens with the necessary surgical care while protecting both patients, and staff. This document presents current recommendations regarding surgery during the COVID-19 pandemic in Poland.

17

Dieta w profilaktyce osteoporozy – zalecenia i kontrowersje

51%

Białokoz-Kalinowska I., Konstantynowicz J., Abramowicz P., Piotrowska-Jastrzębska J.

Pediatria i Medycyna Rodzinna

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2013

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vol. 9

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issue 4

350-356

EN

Osteoporosis is a systemic metabolic disease characterized by loss of bone mass and its impaired microarchitecture, resulting in an increased risk of fragility fracture. Epidemiological data indicate an increase in the incidence of osteoporotic fractures worldwide. The high cost of health, social and economic treatment of osteoporosis requires seeking effective methods of prevention. Considering the multifactorial aetiology of osteoporosis, to the well documented risk factors belong: age, gender, ethnogenetic factors, current or history of chronic disease, steroid therapy and lifestyle. The modifying lifestyle factors as nutrition and physical activity are the potential tools for effective primary prevention of osteoporosis addressed to the whole of society, with particular emphasis on the paediatric population. The results of previous studies evaluating the effect of diet on the reduction of osteoporotic fractures are ambiguous, difficult to interpret and translate into specific dietary recommendations. Although there is a lot of evidence of beneficial effects on skeletal metabolism due to intake of various nutrients (macro- and micronutrients, vitamins D, K and C, isoflavones, plant, polyunsaturated fatty acids omega-3), but both the intake assessment of these nutrients and the monitoring their impact on bone remains extremely difficult in practice. Beneficial role of calcium and vitamin D in mineral homeostasis and bone metabolism has been thoroughly proven, however, further studies are needed, particularly prospective and randomized, in order to determine the optimal calcium intake, dose, bioavailability and nutrient sources, and indications for preventive supplementation. Due to the wide‑spread deficit and insufficient dietary intake of vitamin D, in the light of current guidelines for osteoporosis prevention, the entire population should receive supplementation of vitamin D in the doses strictly dependent on age, sex and season.

PL

Osteoporoza jest układową chorobą metaboliczną charakteryzującą się zanikiem masy kostnej i jej zaburzoną mikroarchitekturą, prowadzącą do wzmożonej łamliwości kości. Dane epidemiologiczne wskazują na wzrost częstości złamań osteoporotycznych. Wysokie koszty zdrowotne, społeczne i ekonomiczne leczenia osteoporozy skłaniają do poszukiwania skutecznych metod profilaktyki. Rozważając wieloczynnikową etiologię schorzenia, wśród udokumentowanych czynników ryzyka należy wymienić: wiek, płeć, uwarunkowania etniczno-genetyczne, aktualne lub przebyte przewlekłe choroby, steroidoterapię oraz styl życia. Właśnie w czynnikach modyfikujących styl życia, obejmujących żywienie i aktywność fizyczną (obciążenia mechaniczne kości), upatruje się możliwość korekty masy szkieletowej i jakości tkanki kostnej, efektywnej pierwotnej profilaktyki osteoporozy skierowanej do całego społeczeństwa, ze szczególnym uwzględnieniem populacji dzieci i młodzieży. Wyniki dotychczasowych badań oceniających wpływ diety na redukcję złamań osteoporotycznych są niejednoznaczne, trudne do interpretacji i przełożenia na konkretne zalecenia żywieniowe. Wprawdzie istnieje szereg dowodów korzystnego działania pewnych składników żywieniowych na metabolizm szkieletowy w okresie rozwoju i inwolucji (biopierwiastki, witaminy D, K i C, izoflawony roślinne, wielonienasycone kwasy tłuszczowe omega-3), ale zarówno ocena spożycia tych czynników pokarmowych, jak i monitorowanie ich wpływu na kość w praktyce pozostają niezwykle trudne. Korzystna rola wapnia i witaminy D w homeostazie mineralnej ustroju i metabolizmie kostnym została gruntownie udowodniona, jednakże konieczne są dalsze badania, zwłaszcza prospektywne z randomizacją, w celu ustalenia optymalnej podaży wapnia, dawki, biodostępności i jego źródeł pokarmowych oraz wskazań do prewencyjnej suplementacji. Ze względu na powszechny deficyt i niedostateczną podaż dietetyczną witaminy D zgodnie z aktualnymi wytycznymi profilaktyki osteoporozy cała populacja powinna zostać objęta suplementacją tego związku, w ściśle określonych dawkach, zależnych od wieku, płci i pory roku.

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