BACKGROUND & AIMS: :The NCCN HER2 Testing in Breast Cancer Task Force was convened to critically evaluate the ability of the level of HER2 expression or gene amplification in breast cancer tumors to serve as a prognostic and a predictive factor in the metastatic and adjuvant settings, to assess the reliability of the methods of measuring HER2 expression or gene amplification in the laboratory, and to make recommendations regarding the interpretation of test results. The Task Force is a multidisciplinary panel of 24 experts in breast cancer representing the disciplines of medical oncology, pathology, radiation oncology, surgical oncology, epidemiology, and patient advocacy. Invited members included members of the NCCN Breast Cancer Panel and other needed experts selected solely by the NCCN. During a 2-day meeting, individual task force members provided didactic presentations critically evaluating important aspects of HER2 biology and epidemiology: HER2 as a prognostic and predictive factor; results from clinical trials in which trastuzumab was used as a targeted therapy against HER2 in the adjuvant and metastatic settings; the available testing methodologies for HER2, including sensitivity, specificity, and ability to provide prognostic and predictive information; and the principles on which HER2 testing should be based. Each task force member was charged with identifying evidence relevant to their specific expertise and presentation. Following the presentations, an evidence-based consensus approach was used to formulate recommendations relating to the pathologic and clinical application of the evidence to breast cancer patient evaluation and care. In areas of controversy, this process extended beyond the meeting to achieve consensus. The Task Force concluded that accurate assignment of the HER2 status of invasive breast cancer is essential to clinical decision making in the treatment of breast cancer in both adjuvant and metastatic settings. Formal validation and concordance testing should be performed and reported by laboratories performing HER2 testing for clinical purposes. If appropriate quality control/assurance procedures are in place, either immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH) methods may be used. A tumor with an IHC score of 0 or 1+, an average HER2 gene/chromosome 17 ratio of less than 1.8, or an average number of HER2 gene copies/cell of 4 or less as determined by FISH is considered to be HER2 negative. A tumor with an IHC score of 3+, an average HER2 gene/chromosome 17 ratio of greater than 2.2 by FISH, or an average number of HER2 gene copies/cell of 6 or greater is considered HER2 positive. A tumor with an IHC score of 2+ should be further tested using FISH, with HER2 status determined by the FISH result. Tumor samples with an average HER2 gene/chromosome ratio of 1.8 to 2.2 or average number of HER2 gene copies/cell in the range of greater than 4 to less than 6 are considered to be borderline, and strategies to assign the HER2 status of such samples are proposed.

背景与目标： : 乳腺癌工作组的NCCN HER2测试是为了严格评估乳腺癌肿瘤中HER2表达或基因扩增水平在转移和辅助环境中作为预后和预测因素的能力，评估实验室中测量HER2表达或基因扩增方法的可靠性，并就测试结果的解释提出建议。该工作组是由24位乳腺癌专家组成的多学科小组，代表医学肿瘤学，病理学，放射肿瘤学，外科肿瘤学，流行病学和患者倡导等学科。受邀成员包括NCCN乳腺癌小组的成员以及NCCN单独挑选的其他所需专家。在为期2天的会议中，个别工作组成员提供了教学报告，批判性地评估了HER2生物学和流行病学的重要方面: HER2作为预后和预测因素; 曲妥珠单抗在辅助和转移环境中被用作针对HER2的靶向治疗的临床试验结果; HER2可用的测试方法，包括敏感性，特异性以及提供预后和预测信息的能力; 以及HER2测试应基于的原则。每个工作队成员都负责确定与其特定专业知识和陈述相关的证据。演讲结束后，使用基于证据的共识方法来制定有关证据在乳腺癌患者评估和护理中的病理和临床应用的建议。在有争议的领域，这一进程超出了会议的范围，以达成共识。工作组得出结论，准确分配浸润性乳腺癌的HER2状态对于辅助和转移性乳腺癌治疗的临床决策至关重要。正式验证和一致性测试应由进行HER2测试的实验室进行并报告，以用于临床目的。如果有适当的质量控制/保证程序，则可以使用免疫组织化学 (IHC) 或荧光原位杂交 (FISH) 方法。IHC评分为0或1 + 、平均HER2基因/染色体17比率小于1.8、或平均HER2基因拷贝数/细胞数为4或更少 (由FISH测定) 的肿瘤被认为是HER2阴性。IHC评分为3 + 、FISH平均HER2基因/17号染色体比率大于2.2或HER2基因拷贝/细胞平均数为6或更大的肿瘤被认为是HER2阳性。IHC评分为2 + 的肿瘤应使用FISH进一步检测，HER2状态由FISH结果确定。具有1.8至2.2的平均HER2基因/染色体比率或HER2基因拷贝/细胞的平均数在大于4至小于6的范围内的肿瘤样品被认为是临界的，并且提出了分配此类样品的HER2状态的策略。

BACKGROUND & AIMS: :Eating disorders have a high rate of onset in school-aged children. School staff are in an excellent position to spot the early warning signs and offer support during recovery. This article explores the findings from focus groups conducted with 63 members of staff from 29 UK schools with the aims of (i) understanding whether they are in a good position to support students with eating disorders and (ii) to generate recommendations regarding school staff's training needs for spotting and supporting eating disorders. Participants took part in semi-structured focus groups. These were transcribed and analysed using content analysis principles. Five key themes emerged: (i) many staff do not have a basic understanding of eating disorders, (ii) eating disorders are taboo in the staffroom, (iii) staff do not feel comfortable talking to students about eating disorders, (iv) support is needed to ensure the teacher-parent relationship is a positive one and (v) school staff would welcome practical ideas for how they can best support students during the recovery period. The findings show that school staff currently feel ill-equipped to support students with eating disorders and endorse a need for focused training for school staff to better enable them to support students with eating disorders.

背景与目标： : 进食障碍在学龄儿童中发病率很高。学校工作人员处于很好的位置，可以发现预警信号并在恢复过程中提供支持。本文探讨了来自英国29所学校的63名工作人员的焦点小组的发现，目的是 (i) 了解他们是否处于支持饮食失调学生的良好位置，以及 (ii) 提出有关学校工作人员的建议。发现和支持饮食失调的培训需求。参与者参加了半结构化的焦点小组。使用内容分析原理对这些内容进行转录和分析。出现了五个主要主题 :( i) 许多工作人员对饮食失调没有基本的了解，(ii) 饮食失调是工作人员的禁忌，(iii) 工作人员不愿意与学生谈论饮食失调，(iv) 需要支持以确保教师与父母的关系是积极的，并且 (v) 学校工作人员欢迎有关如何在恢复期为学生提供最佳支持的实际想法。调查结果表明，学校工作人员目前感到不具备支持饮食失调的学生的能力，并赞同需要对学校工作人员进行重点培训，以更好地使他们能够支持饮食失调的学生。

BACKGROUND & AIMS: :With the daily number of confirmed COVID-19 cases and associated deaths rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and other consequences of the health care crisis. Comprising more than half of the global health care workforce and the highest proportion of direct patient care time than any other health professional, nurses are at the forefront of this crisis. Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. Thus, the primary aim herein is to provide recommendations for palliative nurses and other health care stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19 and, by extension, in anticipation of future public health crises.

背景与目标： : 新型冠状病毒肺炎病例数和相关死亡人数呈指数级增长，全球范围内的社会结构正受到恐慌、不确定性、恐惧和医疗危机的其他后果的影响。护士占全球卫生保健工作人员的一半以上，直接病人护理时间的比例比任何其他卫生专业人员都高，护士处于这场危机的最前沿。在不断发展新型冠状病毒肺炎大流行期间，姑息护士将越来越多地行使他们在症状管理、道德、沟通和临终关怀等关键技能方面的专业知识。关于新型冠状病毒肺炎的姑息治疗反应的文献激增，然而，关于姑息护士的独特贡献及其在减轻这场危机后遗症方面的重要作用存在严重差距。因此，本文的主要目的是为姑息性护士和其他医疗保健利益相关者提供建议，以确保他们的最佳价值得以实现，并在新型冠状病毒肺炎期间促进他们的福祉和复原力，进而促进对未来公共卫生危机的预期。

BACKGROUND & AIMS: :In a recent cluster analysis, it has been shown that patients with peripheral neuropathic pain can be grouped into 3 sensory phenotypes based on quantitative sensory testing profiles, which are mainly characterized by either sensory loss, intact sensory function and mild thermal hyperalgesia and/or allodynia, or loss of thermal detection and mild mechanical hyperalgesia and/or allodynia. Here, we present an algorithm for allocation of individual patients to these subgroups. The algorithm is nondeterministic-ie, a patient can be sorted to more than one phenotype-and can separate patients with neuropathic pain from healthy subjects (sensitivity: 78%, specificity: 94%). We evaluated the frequency of each phenotype in a population of patients with painful diabetic polyneuropathy (n = 151), painful peripheral nerve injury (n = 335), and postherpetic neuralgia (n = 97) and propose sample sizes of study populations that need to be screened to reach a subpopulation large enough to conduct a phenotype-stratified study. The most common phenotype in diabetic polyneuropathy was sensory loss (83%), followed by mechanical hyperalgesia (75%) and thermal hyperalgesia (34%, note that percentages are overlapping and not additive). In peripheral nerve injury, frequencies were 37%, 59%, and 50%, and in postherpetic neuralgia, frequencies were 31%, 63%, and 46%. For parallel study design, either the estimated effect size of the treatment needs to be high (>0.7) or only phenotypes that are frequent in the clinical entity under study can realistically be performed. For crossover design, populations under 200 patients screened are sufficient for all phenotypes and clinical entities with a minimum estimated treatment effect size of 0.5.

背景与目标： : 在最近的聚类分析中，已经表明，根据定量感觉测试图谱，周围神经性疼痛患者可以分为3种感觉表型，其主要特征是感觉丧失，完整的感觉功能和轻度的热痛觉过敏和/或异常性疼痛，或失去热检测和轻度机械痛觉过敏和/或异常性疼痛。在这里，我们提出了一种将单个患者分配到这些亚组的算法。该算法是不确定的-即，可以将患者分类为多个表型-并且可以将患有神经性疼痛的患者与健康受试者分开 (敏感性: 78%，特异性: 94%)。我们评估了患有糖尿病性多发性神经病 (n = 151)，周围神经损伤 (n = 335)，和带状疱疹后神经痛 (n = 97)，并提出需要筛选的研究人群的样本量，以达到足以进行表型分层研究的亚群。糖尿病多发性神经病中最常见的表型是感觉丧失 (83%)，其次是机械痛觉过敏 (75%) 和热痛觉过敏 (34%，注意百分比是重叠的而不是累加的)。在周围神经损伤中，频率为37%，59% 和50%，在带状疱疹后神经痛中，频率为31%，63% 和46%。对于平行研究设计，治疗的估计效果大小需要高 (>0.7)，或者仅可以实际执行在所研究的临床实体中频繁出现的表型。对于交叉设计，筛选的200患者人群足以满足所有表型和临床实体，最小估计治疗效果大小为0.5。

BACKGROUND & AIMS: :Different methods of telomere length measurement are used to identify patients with telomeropathies. In our lab, we established four different methods for telomere length measurement, terminal restriction fragment (TRF) analysis by Southern blot analysis, quantitative PCR (qPCR), quantitative telomere/centromere fluorescence in situ hybridization (T/C-FISH) and fluorescence in situ hybridization combined with flow cytometry (FlowFISH). The methods each have distinct properties and apart from this-according to our experience and data-may have an impact on the individual result. In this study, we therefore compared and validated these methods measuring 154 healthy individuals of different age groups (newborn-81 years). A linear decline was found for every method (Southern blotting 64 bp per year; qPCR 31 bp per year; T/C-FISH 36 bp per year; FlowFISH 50 bp per year). With the equation of the regression line the values of each method (T/S ratio, T/C value, RTL value) can be expressed in absolute kb. All methods showed acceptable accuracy. The analysis indicated good agreement between all methods, with the best agreement between T/C-FISH and FlowFISH. Here, FlowFISH was the most precise, accurate, and reproducible method compared to the other methods. Based on our data, we emphasize the influence of expertise and experience that is required to produce robust and reliable telomere length analyses. Furthermore, we want to provide the scientific community working in diagnostics and research with data-funded advice on how to choose the appropriate method to safely discriminate between natural variability and pathological telomere shortening in individual cases.

背景与目标： : 不同的端粒长度测量方法用于识别端粒病患者。在我们的实验室中，我们建立了四种不同的端粒长度测量方法，通过Southern印迹分析，定量PCR (qPCR)，端粒/着丝粒荧光原位杂交 (T/C-FISH) 和荧光原位杂交结合流式细胞仪 (FlowFISH) 分析末端限制性片段 (TRF)。根据我们的经验和数据，每种方法都具有不同的属性，除此之外，可能会对单个结果产生影响。因此，在这项研究中，我们比较并验证了这些方法，这些方法测量了154个不同年龄组 (新生儿-81岁) 的健康个体。每种方法均呈线性下降 (每年Southern印迹64 bp; 每年qPCR 31 bp; 每年T/C-FISH 36 bp; 每年FlowFISH 50 bp)。利用回归线的方程，每种方法的值 (T/S比，T/C值，RTL值) 都可以用绝对kb表示。所有方法均显示出可接受的准确性。分析表明所有方法之间具有良好的一致性，T/C-鱼和FlowFISH之间具有最佳的一致性。与其他方法相比，FlowFISH是最精确，准确和可重现的方法。根据我们的数据，我们强调产生可靠而可靠的端粒长度分析所需的专业知识和经验的影响。此外，我们希望为从事诊断和研究的科学界提供数据资助的建议，以了解如何选择适当的方法来安全地区分个别情况下的自然变异性和病理性端粒缩短。

BACKGROUND & AIMS: BACKGROUND:Perforation after endoscopic retrograde cholangiopancreatography (ERCP) is uncommon, and its management is dependent on the mechanism and the graded classification of injury. METHODS:Records of patients undergoing ERCP were analyzed over a 16-year period, patterning the types of injuries, diagnosis, management, and patient outcome. Type I injuries damage the medial or lateral duodenal wall before sphincter cannulation. Type II injuries are periampullary and occur as a result of a precut or a papillotomy. Type III injuries occur secondary to guidewire insertion or stone extraction from the common bile duct. Type IV injuries are probably microperforations that are noted on excessive insufflation during and after ERCP withdrawal. RESULTS:Between 1995 and 2011, 27 perforations were identified from 1,638 ERCP procedures (1.6%). Nearly half of the procedures were regarded as difficult by the endoscopist, with 70% of the ERCPs (19 of 27) being for therapeutic indications. There were 5 type I, 12 type II, 5 type III, and 5 type IV perforations, of which 18 cases were diagnosed at the time of ERCP. Delayed diagnosis of type I perforations that were associated with free intraperitoneal air and contrast leakage proved fatal. Most type II perforations required immediate surgery with pyloric exclusion; delayed surgery with simple drainage had a high mortality rate. Most type III and type IV injuries can successfully be managed conservatively without delayed sepsis. CONCLUSIONS:In perforation, the mechanism of injury during ERCP predicts the need for surgical management. Type I and type II injuries require early diagnosis and aggressive surgery, whereas type III and type IV injuries may be managed conservatively.

背景与目标：

BACKGROUND & AIMS: :Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.What is Known:• Iron deficiency (ID) is one of the most common challenges faced by pediatricians.• Significant progress in the diagnosis and therapy of ID has been made over the last decade.What is New:• Our expert panel provides ID management recommendations based on the best available evidence.• They include strategies for ID diagnosis and therapy, both oral and intravenous.

背景与目标： : 缺铁是影响全世界儿童和青少年的最普遍的营养缺乏症。一致的流行病学数据表明，在三个时间点，缺铁的发生率增加: 在新生儿期，学龄前儿童和青少年，尤其影响女性。结论: 本叙述性综述集中于儿童时期缺铁的最暗示性症状，描述了有无贫血情况下的诊断程序，并提供了基于瑞士专家的儿科治疗建议。• 缺铁 (ID) 是儿科医生面临的最常见挑战之一。• 在过去的十年中，ID的诊断和治疗取得了重大进展。• 我们的专家小组根据现有的最佳证据提供ID管理建议。• 包括ID诊断和治疗的策略，包括口服和静脉注射。

BACKGROUND & AIMS: BACKGROUND AND AIMS:Pancreatic cysts are increasingly diagnosed, mainly during abdominal imaging performed for other reasons. Between pancreatic cystic neoplasm, intraductal papillary mucinous neoplasms are the most common pre-malignant entities. Intraductal papillary mucinous neoplasms involving side branches overall harbor a low risk of malignancy, and in the recent past, a progressively more conservative approach has been consolidated. Purpose of this report is to summarize the evidence supporting the current practice for the management of branch duct intraductal papillary mucinous neoplasm and to offer a useful practical guide from first observation to post-operative follow-up. MATERIALS AND METHODS:Review of the most important scientific literature on intraductal papillary mucinous neoplasms was made. In this review article, we also report the experience of a high volume center in managing Pancreatic cystic neoplasms. RESULTS:The correct management during surveillance still is a matter of debate, since many guidelines have been published suggesting different clinical approaches. Recently, follow-up discontinuation has also been proposed in selected cases. CONCLUSION:Despite significant improvements made by the increase of evidence, selecting surgical candidates because of an increased risk of malignant progression remains an unsolved issue and a hot topic for pancreatologists.

背景与目标：

BACKGROUND & AIMS: :The < Standards, Options : Recommendations > (SOR) project has been undertaken by the French National Federation of Cancer Centers (FNCLCC) is now part of the French National Cancer Institute. The project involves the development and updating of evidence-based Clinical Practice Guidelines (CPG) in oncology. This paper is a summary version of the full clinical practice guideline presenting the updated recommendations for management of patients with salivary gland malignant tumours. Recommendations on radiotherapy have been updated to underline new Options on more and more accessible emerging techniques including intensity-modulated radiotherapy, 3D conformational radiotherapy, Cyberknife, tomotherapy, protontherapy and particle accelerators producing carbon ions (e.g. last generation hadrontherapy).

背景与目标： : <标准，选项: 建议> (SOR) 项目已由法国国家癌症中心联合会 (FNCLCC) 承担，现已成为法国国家癌症研究所的一部分。该项目涉及肿瘤学循证临床实践指南 (CPG) 的开发和更新。本文是完整的临床实践指南的摘要版本，提出了唾液腺恶性肿瘤患者管理的最新建议。关于放疗的建议已经更新，以强调越来越多的新兴技术的新选择，包括调强放疗，3D构象放疗，射波刀，断层疗法，质子疗法和产生碳离子的粒子加速器 (例如上一代强子疗法)。

BACKGROUND & AIMS: :The recent introduction of newborn screening for severe primary T and B cell deficiencies in Switzerland allows rapid identification of patients with severe combined immunodeficiency (SCID). Outcomes for SCID are greatly improved by early diagnosis and treatment with allogeneic haematopoietic stem cell transplantation or, in selected cases, gene therapy. National centralised newborn screening is performed in Switzerland since January 2019 using a combined T cell receptor excision circles (TREC) / κ-deleting recombination excision circles (KREC) assay, also revealing infants with non-SCID severe T and B cell disorders, who are often diagnosed with a substantial delay. Here, we outline the screening procedure currently performed in Switzerland and give recommendations for diagnostic evaluations and precautionary measures against infection in children with abnormal screening test results.

背景与目标： : 最近在瑞士引入的新生儿筛查严重的原发性T和b细胞缺陷，可以快速识别患有严重联合免疫缺陷 (SCID) 的患者。通过同种异体造血干细胞移植或在某些情况下进行基因治疗，可以大大改善SCID的结果。自2019年1月以来，瑞士进行了全国集中新生儿筛查，使用了联合T细胞受体切除圈 (TREC) / & kappa;-删除重组切除圈 (KREC) 分析，还揭示了患有非SCID的严重T和b细胞疾病的婴儿，这些婴儿通常被诊断为严重延迟。在这里，我们概述了目前在瑞士进行的筛查程序，并为筛查结果异常的儿童提供了诊断评估和预防感染的建议。

BACKGROUND & AIMS: BACKGROUND:Over the course of the past two decades autologous chondrocyte implantation (ACI) has become an important surgical technique for treating large cartilage defects. The original method using a periostal flap has been improved by using cell-seeded scaffolds for implantation, the matrix-based autologous chondrocyte implantation (mb-ACI) procedure. MATERIAL AND METHODS:Uniform nationwide guidelines for post-ACI rehabilitation do not exist. A survey was conducted among the members of the clinical tissue regeneration study group concerning the current rehabilitation protocols and the members of the study group published recommendations for postoperative rehabilitation and treatment after ACI based on the results of this survey. RESULTS:There was agreement on fundamentals concerning a location-specific rehabilitation protocol (femoral condyle vs. patellofemoral joint). With regard to weight bearing and range of motion a variety of different protocols exist. Similar to this total agreement on the role of magnetic resonance imaging (MRI) for postsurgical care was found but again a great variety of different protocols exist. CONCLUSIONS:This manuscript summarizes the recommendations of the members of the German clinical tissue regeneration study group on postsurgical rehabilitation and MRI assessment after ACI (level IVb/EBM).

背景与目标：

BACKGROUND & AIMS: :This article discusses the proper handling of the malignant colon polyp, that is, polypoid lesions that appear endoscopically to represent adenomas and histologically reveal an invasive carcinoma component, from the time of endoscopy to the pathologic diagnosis. Prognostically important pathologic features and a paradigm to guide treatment decisions are presented.

背景与目标： : 本文讨论了从内窥镜检查到病理诊断的恶性结肠息肉的正确处理，即内镜下出现的息肉样病变代表腺瘤，并在组织学上揭示了浸润性癌的组成部分。提出了预后重要的病理特征和指导治疗决策的范例。

BACKGROUND & AIMS: :The Italian Society of Preventive Medicine for Health Care Workers has examined the guidelines recently published by the Italian Ministry of Health for implementation of safe handling practices for antineoplastic drugs and produced recommendations. On the basis of literature data and the field research carried out by the Society, different aspects covering risk assessment, environmental and biological monitoring, workplace and individual protection measures, education and training of health care and technical personnel, health surveillance programs, were focused on. The creation of a single central unit for preparing antineoplastic drugs or at least a drastic reduction in the number of preparation units currently operating in each hospital are the most relevant objectives of both the guidelines and the Society document. This must be accompanied by correct management of technical and organizational measures, improvement of safety and health of personnel involved in different activities and reduction of the number of exposed subjects. Finally the importance is stressed of clear specific mandatory procedures with which to manage and control the different aspects of job organization.

背景与目标： : 意大利卫生保健工作者预防医学学会审查了意大利卫生部最近发布的实施抗肿瘤药物安全处理实践的指南，并提出了建议。在文献数据和学会进行的实地研究的基础上，重点关注了风险评估，环境和生物监测，工作场所和个人保护措施，卫生保健和技术人员的教育和培训，健康监测计划等各个方面。建立一个用于制备抗肿瘤药物的中央单元，或者至少大幅减少每个医院目前正在运行的制备单元的数量，是指南和社会文件中最相关的目标。这必须伴随着对技术和组织措施的正确管理，改善参与不同活动的人员的安全和健康，并减少暴露对象的数量。最后，强调了明确的特定强制性程序来管理和控制工作组织的不同方面的重要性。

BACKGROUND & AIMS: :This study adds to research on family court's response to custody in the context of intimate partner abuse (IPA). Mediation is often used to assist family court with custody negotiation; however, debate exists in the field regarding its use when IPA exists. The following study examines experiences with court mediation among a sample of victimized mothers who divorced abusive husbands. Mixed-method data were collected from 19 women. Findings demonstrate that abuse is rarely considered in custody recommendations, as most court mediators prefer joint custody. Implications for the ongoing debate, as well as future directions for research, are discussed.

背景与目标： : 这项研究增加了对家庭法院在亲密伴侣虐待 (IPA) 背景下对监护权的反应的研究。调解通常用于协助家庭法院进行监护权谈判; 但是，当IPA存在时，有关其使用的辩论在该领域存在。以下研究考察了与虐待丈夫离婚的受害母亲样本中法院调解的经验。从19名女性中收集了混合方法数据。调查结果表明，在监护权建议中很少考虑虐待，因为大多数法院调解员更喜欢联合监护权。讨论了正在进行的辩论的含义以及未来的研究方向。

BACKGROUND & AIMS: UNLABELLED:Simultaneous liver and kidney transplantation (SLKT) remains the procedure of choice for patients with both endstage liver disease and kidney failure. Stringent guidelines are needed to avoid unnecessary kidney transplantation. A recent consensus meeting proposed criteria based on the Modified Diet in Renal Disease (MDRD)-6 equation to estimate glomerular filtration rate (GFR). The aims of this study were to compare GFR equations to true GFR in candidates for liver transplantation (LT) and to determine the impact of inaccuracies on the current guidelines for SLKT. Three hundred stable cirrhosis patients evaluated for LT were studied. All patients had iohexol clearance to measure GFR at evaluation under stable conditions. Measured GFR (mGFR) was compared to MDRD-4, MDRD-6, and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. MDRD-6 was the most accurate equation to predict GFR. In the 290 patients with mGFR >30 mL/min/1.73 m(2), 15 patients (7%) had estimated GFR (eGFR) ≤40 mL/min/1.73 m(2) based on the MDRD-6 equation, defining "discordant" patients. Among them, two underwent SLKT and 13 underwent LT alone. None of those who survived more than 1 year after LT alone (n = 8) developed renal dysfunction thereafter. In multivariate analysis, discordant patients were older (P = 0.03) and had lower sodium level (P = 0.02). CONCLUSION:The MDRD-6 equation was superior to other equations at identifying cirrhosis patients with true GFR <30 mL/min/1.73 m(2). However, the MDRD-6 equation also tended to underestimate renal function in a subgroup of patients with true GFR >30 mL/min/1.73 m(2), with a potential risk of unnecessary kidney transplantation if applying current U.S. recommendations for SLKT.

背景与目标：