BACKGROUND & AIMS: BACKGROUND AND PURPOSE:The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD:Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS:The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION:The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.

背景与目标： 背景与目的：本项目的目的是为在临床上可识别的缺血性或出血性脑血管意外（单发或偏瘫）后出现偏瘫或偏瘫的成年患者（> 18岁）的治疗中使用的13种类型的物理康复干预措施创建指南。 CVA）。
方法：渥太华方法小组使用Cochrane协作方法，从比较对照试验中鉴定并合成了证据。然后，该小组成立了一个专家小组，为评估证据和推荐的强度制定了一套标准。通过共识确定患者重要的结局，但前提是这些结局必须以经过验证的可靠量表进行评估。
结果：渥太华专家组针对涉及卒中后康复的各种类型的物理康复干预措施的使用提出了147项临床有益的积极建议。
讨论与结论：渥太华小组建议使用治疗性锻炼，任务导向训练，生物反馈，步态训练，平衡训练，约束性运动疗法，肩关节半脱位治疗，电刺激，经皮电神经刺激，超声治疗，针灸，以及中风后管理中康复的强度和组织。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :There is strong evidence for an association between overgrowth disorders such as Beckwith-Wiedemann syndrome and the development of neoplasia. An increased cancer risk has also been observed in individuals with isolated hemihyperplasia. We critically review the evidence for tumour surveillance in Beckwith-Wiedemann syndrome and isolated hemihyperplasia and suggest local practice guidelines.

背景与目标： ：有充分的证据表明过度生长疾病（例如Beckwith-Wiedemann综合征）与赘生物形成之间存在关联。在患有单纯性偏增生的个体中也观察到增加的癌症风险。我们批判性地审查了Beckwith-Wiedemann综合征和孤立的半定量增生的肿瘤监测证据，并提出了当地的实践指南。

BACKGROUND & AIMS: BACKGROUND:To determine guidelines for the management of perineal small bowel fistula (PSF) after total or posterior pelvic exenteration. METHODS:During 15 years, 315 curative pelvic exenterations were performed. PSF occurred in 15 patients (3.5%). We retrieved the precise modality of radiotherapy (fields and doses) and management of all patients (type of surgery, number of surgery and mortality). Delay of occurrence was divided in early (within 30 days or before hospital discharge) and delayed. RESULTS:All patients underwent surgery. Mortality rate was 13%. Fourteen patients (93%) had history of radiotherapy. No PSF was noted after anterior pelvic exenteration. Higher frequency of PSF was noted after total pelvic exenteration versus posterior pelvic exenteration (P = 0.04). Early PSF occurred in four patients (27%) with higher frequency of small bowel intraoperative injury. Late PSF occurred in 11 patients (73%) divided in small bowel injury in contact with pelvic staples (n = 4) and disease recurrence (n = 6, local recurrence or carcinomatosis). One patient had delayed PSF by ulceration of small bowel in contact with pelvic drain. CONCLUSION:PSF was a life-threatening complication of pelvic exenteration. Radiotherapy leads to weaken small bowel with difficulty of cicatrisation. During pelvic exenteration: (a) extreme careful dissection and interposition of great omentum could avoid small bowel injury, (b) control of pelvic vessels and closure of rectum remnant should not used staplers. Intraoperative management of PSF used successful simple repair in case of early PSF or segmentary resection indeed enlarged to right colon in case of delayed PSF. Postoperative courses had to use intravenous hyperalimentation and digestive tract discharge.

背景与目标： 摘要背景：确定盆腔全盆或后盆取出后会阴小肠瘘（PSF）的治疗指南。
方法：在15年的时间里，进行了3​​15例根治性盆腔切除术。 PSF发生在15例患者中（3.5％）。我们检索了放疗的精确方式（范围和剂量）和所有患者的治疗方法（手术类型，手术次数和死亡率）。延迟发生的时间分为早期（30天以内或出院前）并延迟。
结果：所有患者均接受手术治疗。死亡率为13％。十四名患者（93％）有放疗史。骨盆前部脱出后未发现PSF。盆腔全切术后PSF发生频率高于盆腔后全切术（P = 0.04）。早期PSF发生在四例（27％）小肠手术中发生率较高的患者中。晚期PSF发生在11例患者中（73％），分为小肠损伤与骨盆吻合钉（n = 4）和疾病复发（n = 6，局部复发或癌变）。一名患者因与肠盆引流接触的小肠溃疡而延迟了PSF。
结论：PSF是导致盆腔引伸死亡的并发症。放射疗法会导致小肠变弱，难以愈合。在盆腔排出术中：（a）仔细仔细地解剖和插入大网膜可以避免小肠损伤；（b）控制盆腔血管和关闭直肠残余物，不应该使用吻合器。 PSF的术中管理是在PSF早期的情况下成功进行了简单的修复，或在PSF延迟的情况下确实扩大到了右结肠的部分切除术。术后课程必须使用静脉营养过高和消化道分泌物。

BACKGROUND & AIMS: :With ever more guidelines being published, Lois Rogers looks at their development and shortcomings

背景与目标： ：随着更多准则的发布，路易斯·罗杰斯（Lois Rogers）着眼于它们的发展和不足

BACKGROUND & AIMS: :Hepatitis C virus (HCV) infection is a serious health problem leading to cirrhosis, liver failure and hepatocellular carcinoma. The recent introduction of telaprevir, which was approved in November 2011, in combination with peg-interferon and ribavirin is expected to markedly improve the eradication rate of the virus. However, side effects of triple therapy may be severe. In a phase three III clinical trial, 2250 mg of telaprevir, which is the same dosage used in clinical trials in Western countries, was given to Japanese patients. As this dosage is considered to be relatively high for Japanese patients, who typically have lower weight than patients in Western countries, reduction of telaprevir is recommended in the 2012 revision of the guidelines established by the Study Group for the Standardization of Treatment of Viral Hepatitis Including Cirrhosis published by the Ministry of Health, Labour and Welfare of Japan. Other protease inhibitors with fewer side effects are now in clinical trials in Japan. Alternatively, treatment of patients with combination of direct acting antivirals without interferon has been reported. In this review we summarize current treatment options in Japan and discuss how we treat patients with chronic HCV infection.

背景与目标： 丙型肝炎病毒（HCV）感染是导致肝硬化，肝衰竭和肝细胞癌的严重健康问题。近期在2011年11月批准了telaprevir的引入，与聚乙二醇干扰素和利巴韦林联用，有望显着提高该病毒的根除率。但是，三联疗法的副作用可能很严重。在一项三期III期临床试验中，向日本患者提供了2250毫克的telaprevir，与西方国家的临床试验中使用的剂量相同。由于对于日本患者来说此剂量相对较高，通常体重要比西方国家的患者低，因此在2012年修订由病毒性肝炎标准化治疗研究组制定的指南中，建议减少telaprevir的使用，其中包括日本厚生劳动省出版的《肝硬化》。目前，其他副作用较小的蛋白酶抑制剂正在日本进行临床试验。或者，已经报道了将直接作用的抗病毒药物与无干扰素联合治疗的患者。在这篇综述中，我们总结了日本目前的治疗方案，并讨论了我们如何治疗慢性HCV感染患者。

BACKGROUND & AIMS: BACKGROUND:There is a paucity of published guidelines on managing dyspepsia in general practice. Existing guidelines emphasize the role of investigations and drugs rather than management approaches. Focus groups are a means of uncovering the way in which the participants think and work in the pragmatic-setting, and have not previously been formally used in creating guidelines.

AIM:To develop guidelines for the management of dyspepsia and to assess the use of focus groups of general practitioners (GPs) in order to do so.

METHOD:Initial evidence-based guidelines were proposed by a group of four GPs with an audit facilitator, and used for discussion in three focus groups using a standard format. An anthropological analysis of the proceedings led to modifications of the original guidelines, based on knowledge, perceptions and attitudes. The study was set in three distinct locations involving 30 GPs. The outcome measures consisted of feedback, categorized by types of responses, from the analysis of the focus groups and the creation of guidelines.

RESULTS:The resulting guidelines were patient centred and based on the principles of good consultation. They encompassed patients' fears and doctors' clinical uncertainties, and allowed flexibility in the individual patient's management. The focus group methodology exposed a substantial number of GPs to guideline development, and had the added benefits of dissemination, peer review and educational challenge.

CONCLUSION:It was possible to develop guidelines for dyspepsia using focus groups. The methodology had the added benefits of ownership, peer review, exposure of educational gaps and locality factors, and dissemination of good practice. It included steps from evidence review to implementation strategies. The development of this technique could lead to a strategy towards the creation and application of evidence-based and professionally acceptable clinical guidelines and practice on a locality basis nationally.

背景与目标： 背景：在一般情况下，有关消化不良的已发布指南很少。现有指南强调调查和药物的作用，而不是管理方法。焦点小组是揭示参与者在务实环境中思考和工作方式的一种方式，以前从未在制定指南中正式使用过。

AIM ：要发展

METHOD ：最初的循证指南是由一位专家提出的。一组由审核员协助的四个GP，并使用标准格式在三个焦点小组中进行讨论。对程序的人类学分析导致​​根据知识，看法和态度对原始准则进行了修改。该研究在三个不同的地点进行，涉及30个GP。结果测量包括根据反馈类型进行的反馈，对焦点小组的分析以及指南的创建。

结果：结果指南以患者为中心，基于良好协商的原则。它们涵盖了患者的恐惧和医生的临床不确定性，并允许在个体患者的管理中保持灵活性。焦点小组的方法使大量的GP可以接受指南的制定，并具有传播，同行评审和教育挑战的额外好处。

结论：可以为以下方面制定指南消化不良使用焦点小组。该方法具有所有权，同行评议，暴露教育差距和地区因素以及传播良好实践等附加好处。它包括从证据审查到实施策略的步骤。该技术的发展可能会导致制定在全国范围内基于证据的，专业认可的临床指南和实践的策略。