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Survey concerning internal medicine physicians and prolonged QT interval:Knowledge and treatment practices

World Journal of Cardiology 2021年第3期13卷 42-45页

作者： Elizabeth Wendl nelson telles Geoff C Wall Department of Medical Education Internal Medicine Residency ProgramIowa Methodist Medical CenterDes MoinesIA 50311United States Department of Cardiology Internal Medicine Residency ProgramIowa Methodist Medical CenterDes MoinesIA 50311United States Department of Pharmacy Practice Drake University College of Pharmacy and Health SciencesDes MoinesIA 50311United States Internal Medicine Residency Program Iowa Methodist Medical CenterDes MoinesIA 50311United States

Prolongation of the QT interval is associated with adverse cardiac events specifically Torsades de pointes(TdP).There are multiple mediations that have a known,possible,or conditional risk for prolonged QT interval,but general practitioners’knowledge of these medications is *** conducted a survey to assess internal medicine(IM)providers’knowledge of risk factors and medications associated with prolonged QT as well as provider experience and comfort when treating patients with prolonged QT.A 17-question,anonymous survey was constructed in 2019 and distributed to IM providers and residents at a tertiary care *** included demographic information,6 Likert-scale questions gauging provider experience with prolonged QT,and 10 multiple choice clinical vignettes to assess clinical *** was analyzed *** was assessed via clinical vignettes and compared by level of ***-one responses were received out of a total of 87 possible respondents(47.1%response rate).About 70%of respondents see patients with acquired prolonged QT once monthly or more.95%rarely see congenital prolonged *** presented with QTc drug issues,73%of providers seldom or sometimes consulted pharmacy,but about half used online *** average correct score on the clinical vignettes was 5.59/10,with the highest scores seen in attending physicians in their first five years of practice(6.96/10).Our survey suggests that IM providers commonly encounter QT prolonging *** efforts to improve knowledge of drug and patient risk factors for TdP may be needed.

关键词： QTc Torsades de pointes Pharmacotherapy Survey Long QT syndrome Drug interactions

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Updates in the Diagnosis of Gestational Trophoblast Disease

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Health 2023年第1期15卷 48-58页

作者： Maira de Lima Oliveira Mota Marcela Curvêllo Beltrão Elizabeth Bacha Eduardo Fonseca Mascarenhas Filho Maísa Mendonça de Jesus nelson Henriky Felix Mascarenhas Tallys Leandro Barbosa da Silva Maria Fernanda telles Pires de Souza Victoria de Oliveira Carmo Borges Séfora Maria Fragoso Braga Centro Universitário Tiradentes (UNIT) Maceió Brasil Estácio de Juazeiro do Norte (FMJ) Ceará Brasil Universidade Federal de Alagoas (UFAL) Maceió Brasil Sã o Leopoldo Mandic Campinas Brasil Hospital Regional de Arapiraca Arapiraca Brasil

GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis of the pathology results in inadequate classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to point out updated national and international practice protocols of diagnosis of GTD, through an integrative review. Seven articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized (usually one month for Partial Hydatidiform Mole six months for Complete Hydatidiform Mole and one year for Gestational Trophoblastic Neoplasia). Unfortunately, regarding the diagnosis of MH, the guidelines of some countries show the absence or difficulty of access to the karyotype test and ploid p57 or pelvic ultrasound accompanying the uterine curettage, contrary to what is proposed by the IFGO guideline. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.

关键词： Diagnosis Gestational Trophoblastic Disease Updates

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Management of Gestational Trophoblast Disease: A Review Integrative National and International Guidelines

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Health 2022年第12期14卷 1321-1333页

作者： Marcela Curvêllo Beltrão Maira de Lima Oliveira Mota Elizabeth Bacha Lusitania Maria de Barros Livia Helena Gomes de Barros Brandão nelson Henriky Felix Mascarenhas Tallys Leandro Barbosa da Silva Maria Fernanda telles Pires de Souza Séfora Maria Fragoso Braga Victoria de Oliveira Carmo Borges Centro Universitário Tiradentes (UNIT) Maceió Brasil Instituto de Medicina Integral Professor Fernando Figueira (IMIP) Pernambuco Brasil Estácio de Juazeiro do Norte (FMJ) Ceará Brasil Universidade Federal de Alagoas (UFAL) Maceió Brasil Sã o Leopoldo Mandic Campinas Brasil Hospital Regional de Arapiraca Arapiraca Brasil

GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis and treatment of the aforementioned pathology results in inadequate risk classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to compare the different national and international guidelines in the management of GTD, through an integrative review. Nine articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized;in low-risk GTN (Gestational Trophoblastic Neoplasm): chemotherapy with methotrexate or actinomycin D, in high-risk: EMA/CO protocol, in ultra-high-risk EMA/PE, methotrexate with radiotherapy for brain metastases. All medical societies recommend the registration of these patients in GTD screening centers, endorse the use of the IFGO scoring system (2000) and recommend the surgical management of placental site trophoblastic or epithelioid tumors, as chemotherapy is less effective in these cases. The controversies are in the proper follow-up after the treatment of HM, use of ultrasound to evacuate the uterus, administration of anti-D immunoglobulin, time of oxytocin infusion and rescue regimens that can be used in cases of resistant or recurrent GTN. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of

关键词： Guidelines Gestational Trophoblastic Disease Treatment

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