Executive Summary Introduction Methodology Used to Prepare the Guideline Epidemiology Incidence Etiology Major Epidemiologic Points Pathogenesis Major Points for Pathogenesis Modifiable Risk Factors Intubation and Mechanical Ventilation Aspiration, Body Position, and Enteral Feeding Modulation of Colonization: Oral Antiseptics and Antibiotics Stress Bleeding Prophylaxis, Transfusion, and Glucose Control Major Points and Recommendations for Modifiable Risk Factors Diagnostic Testing Major Points and Recommendations for Diagnosis Diagnostic Strategies and Approaches Clinical Strategy Bacteriologic Strategy Recommended Diagnostic Strategy Major Points and Recommendations for Comparing Diagnostic Strategies Antibiotic Treatment of Hospital-acquired Pneumonia General Approach Initial Empiric Antibiotic Therapy Appropriate Antibiotic Selection and Adequate Dosing Local Instillation and Aerosolized Antibiotics Combination versus Monotherapy Duration of Therapy Major Points and Recommendations for Optimal Antibiotic Therapy Specific Antibiotic Regimens Antibiotic Heterogeneity and Antibiotic Cycling Response to Therapy Modification of Empiric Antibiotic Regimens Defining the Normal Pattern of Resolution Reasons for Deterioration or Nonresolution Evaluation of the Nonresponding Patient Major Points and Recommendations for Assessing Response to Therapy Suggested Performance Indicators

Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia the official statement of the American Thoracic Society and the Infectious Disease Society of America (特集 救急診療ガイドライン) -- (海外のガイドライン)

ObjectiveThis update of a 2004 guideline codeveloped by the American Academy of Otolaryngology—Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME.PurposeThe purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical pra...

https://journals.sagepub.com/doi/pdf/10.1177/0194599815623467

Clinical Practice Guideline Otitis Media with Effusion (Update)

Head and neck cancer

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61444-5.pdf

Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis

PIP: Early age at menarche, late age at menopause, and late age at first full-term pregnancy are linked to a modest increase in the risk of developing breast cancer. Some evidence suggests that the earlier the full-term pregnancy, the earlier the period of decreased susceptibility of breast tissue changes begins. Nulliparity is related to an increased risk for breast cancer diagnosed after 40 years old. Multiple full-term pregnancies decrease the risk of breast cancers diagnosed after 40 years regardless of the age at first birth. On the other hand, they may increase the risk for breast cancers diagnosed before 40 years old. Surgical removal of the ovaries protects against breast cancer. Breast feeding apparently protects against breast cancer in China, but a protective effect has not been established in the US. Other than shorter intervals between menstrual periods, which tend to increase the risk, research has not yet made clear the etiologic roles of menstrual cycle characteristics. Other unclear etiologic roles include increased intervals between births, spontaneous and induced abortion, infertility, multiple births at last pregnancy, and hypertension during pregnancy. Researchers tend to accept a mechanism to explain the epidemiologic characteristics of menstrual activity and the increased risk of breast cancer, but no mechanisms have emerged for the other likely risk factors. Greater exposure to estrogen and progesterone simultaneously are linked to early age at menarche, late age at menopause, and shorter menstrual cycle length. So far, data show that long-term combined estrogen/progestin hormone replacement therapy and long-term use of oral contraceptives increase the risk of breast cancer. Moderately increased risks linked to longterm estrogen replacement therapy and obesity in postmenopausal women indicate that estrogen alone influences breast cancer risk. Since much of the research on breast cancer risk factors are inconclusive, more research is needed, especially research examining the probability of prolonged exposure to both estrogens and progesterone concurrently.

Reproductive Factors and Breast Cancer

Background The effect of pregnancy on the risk of breast cancer is not clear. We tested the hypothesis that the risk of breast cancer increases transiently after pregnancy but then falls to a level below that of age-matched nulliparous women. Methods We conducted a case-control study of a nationwide cohort in Sweden, using a computerized record linkage between the Cancer Registry and the Fertility Registry. The study subjects were women born from 1925 through 1960 who were resident citizens of Sweden at the time of the 1960 census. A total of 12,666 patients with breast cancer were compared with 62,121 age-matched control subjects. We used conditional logistic regression to estimate odds ratios for the development of breast cancer at different ages, according to maternal age at first delivery (in uniparous as compared with nulliparous women) and age at second delivery (in biparous as compared with uniparous women). Results Uniparous women were at higher risk of breast cancer than nulliparous women for up ...

Transient Increase in the Risk of Breast Cancer after Giving Birth

Association between fruit and vegetable consumption and oral cancer: a meta-analysis of observational studies

Background
Ambulatory care-sensitive conditions (ACSC), such as hypertension, diabetes, chronic heart failure, chronic obstructive pulmonary disease and asthma, are conditions that can be managed with timely and effective outpatient care reducing the need of hospitalization. Avoidable hospitalizations for ACSC have been used to assess access, quality and performance of the primary care delivery system. The aims of this study were to quantify the proportion of avoidable hospital admissions for ACSCs, to identify the related patient's socio-demographic profile and health conditions, to assess the relationship between the primary care access characteristics and preventable hospitalizations, and the usefulness of avoidable hospitalizations for ACSCs to monitor the effectiveness of primary health care.

/pdf/preventable-hospitalization-and-access-to-primary-health-2z84zxcdjp.pdf

Preventable hospitalization and access to primary health care in an area of Southern Italy.

The purpose of the study is to collect information on the reasons given by dentists, randomly selected from the Italian Dental and Maxillo-Facial Association's, for extracting permanent teeth in Italy. From the 164 dentists responding, 1056 teeth in 839 patients were extracted during two weeks of working activity. More than two-thirds of the teeth were extracted for dental caries (34.4%) and periodontal disease (33.1%). The mean number of teeth extracted per patient showed a significant increasing trend with increasing age, being 1.09 in those from 16 to 39 yr, 1.25 in the 40-59-yr-old group, to 1.54 in those over 59 yr of age (F = 21.44; P < 0.0001). The third molar was the most frequently extracted tooth and 41.3% were removed due to impaction reasons, in particular from the mandible. The first and second molars and the premolars were extracted most often because of caries; more than half of the incisors and the canines were extracted for periodontal reasons; the majority of the teeth removed for prosthetic reasons, 57.1%, were incisors and canines, especially in the mandible; of the teeth extracted for orthodontic reasons, 47.4% were first and second premolars. The prevalence of subjects with at least one tooth extracted for dental caries and for orthodontic reasons were respectively significantly higher in the irregular than the regular attenders (chi-square = 46.55; P < 0.0001), and in the regular than the irregular dental attenders (chi-square = 63.12; P < 0.0001). Dental practitioners should promote targeted initiatives for prevention and treatment of diseases in order to reduce in particular the incidence of tooth extraction because of caries and periodontal disease.

Survey of reasons for extraction of permanent teeth in Italy

CONTEXT. Pneumococcal conjugate bacterial vaccines that are able to prevent invasive disease and mucosal infections have been developed. OBJECTIVE. A meta-analysis of published data from trials on pneumococcal conjugate vaccine was performed to determine the efficacy in reducing the incidence of invasive disease caused by Streptococcus pneumoniae, pneumonia, and acute otitis media in healthy infants younger than 24 months. METHODS. A systematic search of the literature was conducted. Controlled clinical trials had to compare the protective efficacy of the pneumococcal conjugate vaccine in reducing the incidence of invasive disease caused by S pneumoniae, pneumonia, and acute otitis media in healthy infants with placebo or control vaccines. Information was extracted by using a standardized protocol. RESULTS. The efficacy of pneumococcal conjugate vaccine in the reduction of invasive pneumococcal disease was 89% involving vaccine serotypes in both the intention-to-treat and per-protocol analyses and ranged from 63% to 74% for all serotypes. The efficacy to prevent acute otitis media sustained by vaccine serotypes was 55% in the intention-to-treat and 57% in the per-protocol analyses, whereas it was 29% to prevent otitis involving all serotypes in the per-protocol analysis. Finally, in the intention-to-treat and per-protocol analyses, the efficacy to prevent clinical pneumonia was 6% and 7%, respectively, whereas for the prevention of radiograph-confirmed pneumonia it was 29% and 32%, respectively. CONCLUSIONS. The pneumococcal conjugate vaccine produces a significant effect regarding prevention of invasive pneumococcal disease. Results on prevention of otitis or pneumonia have been less striking, but considering the high burden of these diseases in infants, even a low efficacy has potential for tremendous impact on the health of infants in developing and industrialized countries.

Maria Pavia

Papers

Transient Increase in the Risk of Breast Cancer after Giving Birth

Association between fruit and vegetable consumption and oral cancer: a meta-analysis of observational studies

Preventable hospitalization and access to primary health care in an area of Southern Italy.

Survey of reasons for extraction of permanent teeth in Italy

Efficacy of Pneumococcal Vaccination in Children Younger Than 24 Months: A Meta-Analysis