Rinosinusitis – nove smjernice

Diagnosing and Treating Rhinosinusitis: New Guidelines

New Guidelines for Rhinosinusitis

The Infectious Diseases Society of America has published its first-ever recommendations for the diagnosis and management of acute bacterial rhinosinusitis (ABRS) infections.[1] The guidelines used the new GRADE system (Grading of Recommendations Assessment, Development and Evaluation), which is designed to more clearly assess the quality of evidence and report the strength of recommendations.

Because the infection causes inflammation of both the sinuses and the nasal cavity, the ABRS guidelines use the term “rhinosinusitis” instead of the more common “sinusitis.” The purpose of the guidelines is to provide clarity and guidance to physicians and other primary care providers in diagnosing and treating the infection. The guidelines specifically address the following:

  • The inability of existing clinical criteria to accurately differentiate bacterial from viral acute rhinosinusitis, leading to excessive and inappropriate antimicrobial therapy;
  • Gaps in knowledge and quality evidence about empiric antimicrobial therapy for ABRS as a result of imprecise patient selection criteria;
  • Changing prevalence and antimicrobial susceptibility profiles of bacterial isolates associated with ABRS; and
  • The effect of conjugated vaccines for Streptococcus pneumoniae on the emergence of nonvaccine serotypes associated with ABRS.

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Karcinom jednjaka i želuca – nove smjernice

from Gut

William H Allum; Jane M Blazeby; S Michael Griffin; David Cunningham; Janusz A Jankowski; Rachel Wong

Abstract and Introduction

Introduction

Over the past decade the Improving Outcomes Guidance (IOG) document has led to service re-configuration in the NHS and there are now 41 specialist centres providing oesophageal and gastric cancer care in England and Wales. The National Oesophago-Gastric Cancer Audit, which was supported by the British Society of Gastroenterology, the Association of Upper Gastrointestinal Surgeons (AUGIS) and the Royal College of Surgeons of England Clinical Effectiveness Unit, and sponsored by the Department of Health, has been completed and has established benchmarks for the service as well as identifying areas for future improvements.[1–3] The past decade has also seen changes in the epidemiology of oesophageal and gastric cancer. The incidence of lower third and oesophago-gastric junctional adenocarcinomas has increased further, and these tumours form the most common oesophago-gastric tumour, probably reflecting the effect of chronic gastro-oesophageal reflux disease (GORD) and the epidemic of obesity. The increase in the elderly population with significant co-morbidities is presenting significant clinical management challenges. Advances in understanding of the natural history of the disease have increased interest in primary and secondary prevention strategies. Technology has improved the options for diagnostic and therapeutic endoscopy and staging with cross-sectional imaging. Results from medical and clinical oncology trials have established new standards of practice for both curative and palliative interventions. The quality of patient experience has become a significant component of patient care, and the role of the specialist nurse is fully intergrated. These many changes in practice and patient management are now routinely controlled by established multidisciplinary teams (MDTs) which are based in all hospitals managing these patients.

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