New ACC/AHA Aortic Disease Management Guidelines: What do they mean for you?
10:57-14:08
So this is not a new concept but I think what's so important about the document is how all these various numbers and sizes and things that we talk about, that Dr. DeAnda is going to talk about, that we'll talk about when we think about surgical thresholds and things like that we really come back to the person we're seeing because everybody's different the same size is not the same for every person. Some person's risk of surgery is much higher than the next person.
共同での意思決定自体は新しいコンセプトというわけではありません。外科手術の手術を検討する場合には、大動脈のサイズなど、様々な検査値が関わってくるわけですが、最終的には、患者さんご本人と向き合わざるを得ません。というのも、同じ大動脈サイズであったとしても、手術リスクが他の患者さんよりもかなり高い方もおられるなど、それぞれの状況に応じて意味合いは変わってくるからです。
So these numbers are really what they are, there's, they're very important guidelines and we go into these decisions in a shared manner, thinking about the person we're seeing, what their circumstance is, how quickly it got to that point, what the family history is, what the gene is and then trying to decide for that individual. Is it better or lower risk to continue to observe or is it lower risk to take the change chances for surgery whatever that risk might be depending on the individual, Dr. DeAnda?
検査の数値自体は重要な指針となりますが、お互いの意見を共有した形で検討することになります。考慮する項目としては、患者さんの状況、手術しきい値までの到達速度、家族歴、原因遺伝子などです。また、患者さん個々のリスクに応じて、リスクを下げるには、経過観察を続けたほうがいいか、あるいは手術に踏み切ったほうがいいかといったことも考慮します。DeAnda先生のご意見をお聞かせください。
Sorry, I was muted there. You think I would have learned by now how to do this but Dr. Braverman and you, you've hit it the nail on the head. No longer can we really talk about aortic surgery and approaches to patients with aortic disease as one-size-fits-all and, so the shared decision making is not just the doctor sitting there and, and, and talking with the patient but it's also the, the patient talking back to the doctor and expressing their concerns. This is nicely laid out in this slide about some of the considerations, for instance, in the very last point, pregnancy decisions.
Braverman先生のご意見に全く同感です。大動脈手術や患者さんへのアプローチについては、どのケースにも当てはまるパターンというものは存在しません。共同で行う意思決定とは、患者さんが医師の言うことにただ従うことではなく、患者さんも医師に意見を述べ、不安についての意思表明をすることです。スライドの項目の最後にある出産についての決定がその例です。
And, and later on we're going to talk a little bit about this concept of a center of excellence and this is also going to come into play because some of your, some of the options are going to be available surgically and medically are going to be dependent on the experience and expertise of the, of the team that's going to be taking care of you, so all of this, I think, we've finally everyone has been doing this, it is, in some sense, at different centers around the country and around the world but I think we set it down on paper. We just said this is, some of the considerations that you have to be thinking about and, and by putting it down on paper I think we've given patients and their families the opportunity to understand what some of these considerations are I, I hand it back to you, Alan, if you want to expand on that a little bit more, you see these patients as well obviously.
後ほど実績のある医療機関についてのお話をしますが、こちらも重要な項目です。外科的・内科的治療の選択肢については、担当するチームの経験や専門知識によって変わります。世界中あるいは国内の様々な医療機関でこうした治療が受けられるようになってきたように感じていますが、治療選択肢については文書の形で残す必要があると考えます。考慮すべきことについて一部はこのウェビナーで触れていますが、論文に残すことで患者さんやそのご家族に具体的な内容を理解していただけるのではないかと思います。Braverman先生にお返しします。補足があればお願いします。
Thanks, Abe, well I think we'll come back to these gray areas where there had been hard cut points throughout the whole discussion tonight, so Eileen if you can push us forward to the couple slides forward.
DeAnda先生、ありがとうございました。はっきりとした結論が出しにくいトピックではありますが、後ほど再度取り上げたいと思います。では、次のスライドお願いします。
The Marfan Foundation did not participate in the translation of these materials and does not in any way endorse them. If you are interested in this topic, please refer to our website, Marfan.org, for materials approved by our Professional Advisory Board.
The Marfan Foundation は、当翻訳には関与しておらず、翻訳内容に関してはいかなる承認も行っておりません。このトピックに興味をお持ちの方は、Marfan.org にアクセスし、当協会の専門家から成る諮問委員会が承認した内容をご参照ください。
