Guidelines for Management of Urgent Symptoms in Patients with Cholangiocarcinoma and Biliary Stents or Catheters using the Modified RAND/UCLA Delphi Process
| العنوان: | Guidelines for Management of Urgent Symptoms in Patients with Cholangiocarcinoma and Biliary Stents or Catheters using the Modified RAND/UCLA Delphi Process |
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| المؤلفون: | Juan W. Valle, Michael A. Choti, Dasha Cherepanov, Peter A. Mead, John Bridgewater, Neehar D. Parikh, Riad Salem, Jason K. Sicklick, Michael S. Broder, Susan Acquisto, Richard S. Siegel, Rebecca Roberts, Bela Kis, Theodore S. Hong, Lewis R. Roberts, Jonathan R. Whisenant, Renuka Iyer |
| المصدر: | Cancers Volume 12 Issue 9 Cancers, Vol 12, Iss 2375, p 2375 (2020) |
| بيانات النشر: | Multidisciplinary Digital Publishing Institute, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Delphi method, lcsh:RC254-282, digestive system, Delphi, Article, Unmet needs, biliary stent, 03 medical and health sciences, 0302 clinical medicine, medicine, In patient, cardiovascular diseases, Intensive care medicine, neoplasms, Ascending cholangitis, Stent, Jaundice, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, equipment and supplies, digestive system diseases, PTC, Oncology, 030220 oncology & carcinogenesis, biliary cancer, Biliary stent, 030211 gastroenterology & hepatology, biliary emergencies, medicine.symptom, Bilirubin levels, cholangiocarcinoma |
| الوصف: | Background: Patients with cholangiocarcinoma often have indwelling biliary stents or catheters which are prone to obstructions and/or infections studies show that 20&ndash 40% present with fever and/or jaundice requiring urgent treatment in the outpatient setting for which there are no uniform guidelines. The goal was to develop an expert panel consensus on this topic using the modified RAND/UCLA Delphi process to rate treatment appropriateness. Methods: Thirteen expert physicians from relevant specialties, geography, and practice settings were recruited for the panel. Patient scenarios were developed and panelists rated the therapies before and after a face-to-face discussion. The appropriateness of various therapies was rated on a scale from 1&ndash 9 and classified as appropriate, inappropriate, or uncertain. Scenarios with greater than 2 (> 2) ratings of 1&ndash 3 (inappropriate) and greater than 2 (> 2) ratings of 7&ndash 9 (appropriate) were considered to have disagreement and were not assigned an appropriateness rating. Results: Panelists were from all US regions and the UK (8%) and had practiced for a mean 16.5 years (4&ndash 33 years). Panelists rated 480 scenarios before the meeting and re-rated 288 of the clinical scenarios after the meeting. The panelists agreed that ongoing treatment with chemotherapy did not influence decision-making and, therefore, 192 scenarios were excluded from the final list. Disagreement decreased from 37.5% before to 10.4% after the meeting. Consensus on stent/tube manipulation and inpatient antibiotic therapy was obtained and summarized in patients as &ldquo appropriate&rdquo or &ldquo maybe appropriate&rdquo based on a patient&rsquo s bilirubin level at presentation. Conclusions: The Delphi process produced consensus guidelines to fill an unmet need in the urgent management of ascending cholangitis in patients with cholangiocarcinoma. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 2072-6694 |
| DOI: | 10.3390/cancers12092375 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9c0d960edd0cd97bc109c60ca365f346Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....9c0d960edd0cd97bc109c60ca365f346 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20726694 |
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| DOI: | 10.3390/cancers12092375 |