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对新诊断出恶性质瘤的成年人进行护理的模式
Susan M Chang1, Ian F Parney, Wei Huang
1Department of Neurological Surgery, University of California, San Francisco, CA 94143-0350, USA. changs@neurosurg.ucsf.edu
JAMA
|February 3, 2005
概括
这项研究强调了恶性质瘤患者的多样化治疗模式,并指出常见的MRI,手术和放射治疗,但不常见的化疗. 经常使用抗药物与指导方针相矛盾,表明需要更新临床指导方针.
科学领域:
- 神经瘤学神经瘤学
- 临床实践模式 临床实践模式
- 基于证据的医学基于证据的医学.
背景情况:
- 恶性质瘤 (III或IV级) 患者的预后不好,基于有限的证据的治疗指南.
- 对这些患者的护理模式的前性数据很少.
研究的目的:
- 建立基准数据,以比较恶性质瘤护理中的个人实践模式和结果.
- 识别学术和社区环境之间治疗方法的差异.
主要方法:
- 质瘤结局 (GO) 项目招募了565名新诊断为初级III或IV级质瘤的成年患者.
- 数据是通过问卷在入学时,外科手术前和3个月后的随访时间收集的,长达24个月.
- 分析的重点是治疗模式,包括手术管理,术前和术后管理.
主要成果:
- 磁共振成像 (92%) 和瘤切除 (75%) 是常见的. 皮质映射 (19%) 和图像指导 (29%) 等外科辅助是不常见的.
- 术前用皮质类固醇 (99%) 和抗药 (88%) 被广泛使用;抗抑郁药 (8%) 和预防性肝素 (7%) 是罕见的.
- 辅助放射治疗 (87%) 是常见的,而化疗 (54%) 是不太常见的. 在学术和社区环境之间存在显著的实践差异.
结论:
- 目前的实践很大程度上依赖于MRI,手术和辐射,与普遍接受一致.
- 不经常使用化疗可能与文献相矛盾,常规抗药物使用与指导方针相冲突.
- 需要对手术辅助剂,预防性肝素和抗抑郁药进行进一步的研究. 建立临床指导方针可以减少实践的变化.
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