Social:Watchful waiting
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Watchful waiting (also watch and wait or WAW) is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy is used. During this time, repeated testing may be performed.
Related terms include expectant management,[1][2] active surveillance,[3] and masterly inactivity.[4] The term masterly inactivity is also used in nonmedical contexts.[5]
A distinction can be drawn between watchful waiting and medical observation,[6] but some sources equate the terms.[7][8] Usually, watchful waiting is an outpatient process and may have a duration of months or years. In contrast, medical observation is usually an inpatient process, often involving frequent or even continuous monitoring and may have a duration of hours or days.
Medical uses
Often watchful waiting is recommended in situations with a high likelihood of self-resolution if there is high uncertainty concerning the diagnosis, and the risks of intervention or therapy may outweigh the benefits.
Watchful waiting is often recommended for many common illnesses such as ear infections in children;[9] because the majority of cases resolve spontaneously, antibiotics will often be prescribed only after several days of symptoms. It is also a strategy frequently used in surgery prior to a possible operation,[10] when it is possible for a symptom (for example abdominal pain) to either improve naturally or become worse.
Other examples include:
- the diagnosis and treatment of benign prostatic hyperplasia
- depression[11]
- otitis media[12]
- inguinal hernia
- odd behaviors in infants
- Active surveillance of prostate cancer
- non-symptomatic kidney stones
- gender dysphoria[13][14]
Process
Watchful waiting
In many applications, a key component of watchful waiting is the use of an explicit decision tree or other protocol to ensure a timely transition from watchful waiting to another form of management, as needed.[15] This is particularly common in the post-surgical management of cancer survivors, in whom cancer recurrence is a significant concern.
Medical observation
Usually, patients in observation, according to hospital policy, are kept in observation for only 24 or 48 hours before they will be discharged or admitted as an inpatient. Insurance can play a role in how "observation" is defined (for example, US Medicare does not support observation services for over 48 hours).[16]
See also
References
- ↑ Pestana, Carlos (7 April 2020). Pestana's Surgery Notes (Fifth ed.). Kaplan Test Prep. pp. 6–7. ISBN 978-1506254340. ""Signs of a fracture affecting the base of the skull include raccoon eyes, rhinorrhea, and otorrhea or ecchymosis behind the ear. Expectant management is the rule. From our perspective, the significance of a base of the skull fracture is that it indicates that the patient sustained very severe head trauma""
- ↑ "Definition of expectant management - NCI Dictionary of Cancer Terms". https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=616061.
- ↑ "Watchful Waiting or Active Surveillance for Prostate Cancer". https://www.cancer.org/cancer/prostate-cancer/treating/watchful-waiting.html.
- ↑ "Management of asymptomatic aortic stenosis: masterly inactivity but cat-like observation". Heart 78 (3): 215–7. September 1997. doi:10.1136/hrt.78.3.215. PMID 9391278.
- ↑ "Masterly Inactivity - TIME". Time. 1952-08-18. http://www.time.com/time/magazine/article/0,9171,816693,00.html. Retrieved 2010-05-27.
- ↑ "Australian Prostate Cancer Website". http://www.prostatehealth.org.au/phip_4.html?PHPSESSID=e1db774b4be02970795b9b7b95d7fb68#MonitoringNoTreatment.
- ↑ "Prostate cancer guide - MayoClinic.com". http://www.mayoclinic.com/health/prostate-cancer/PC99999/PAGE=PC00018.
- ↑ "Definition of watchful waiting - NCI Dictionary of Cancer Terms". January 1980. http://nci.nih.gov/templates/db_alpha.aspx?CdrID=45942.
- ↑ American Academy of Pediatrics
- ↑ "Is watchful waiting a reasonable approach for men with minimally symptomatic inguinal hernia?". CMAJ 174 (9): 1263–4. April 2006. doi:10.1503/cmaj.060299. PMID 16636325. PMC 1435959. http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=16636325.
- ↑ "Factors associated with primary care clinicians' choice of a watchful waiting approach to managing depression". Psychiatr Serv 58 (1): 72–8. January 2007. doi:10.1176/appi.ps.58.1.72-a. PMID 17215415. http://ps.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=17215415.
- ↑ "Watchful waiting for acute otitis media: are parents and physicians ready?". Pediatrics 118 (2): 849–50. August 2006. doi:10.1542/peds.2005-2786. PMID 16882857. http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=16882857.
- ↑ Kettenis, Peggy Cohen; van de Waal, Henriette Delemarre; Gooren, Louis (August 2008). "The Treatment of Adolescent Transsexuals: Changing Insights". The Journal of Sexual Medicine 5 (8): 1892-1897. doi:10.1111/j.1743-6109.2008.00870.x. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1743-6109.2008.00870.x.
- ↑ de Vries, Annelou; Kettenis, Peggy Cohen (March 2012). "Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach". Journal of Sexuality 59 (3): 301-320. doi:10.1080/00918369.2012.653300. https://www.tandfonline.com/doi/abs/10.1080/00918369.2012.653300.
- ↑ "Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting". JAMA 268 (19): 2678–86. November 1992. doi:10.1001/jama.268.19.2678. PMID 1433687.
- ↑ "Gundersen Lutheran - What is Outpatient Observation?". http://www.gundluth.org/web/misc/pbs.nsf/8a155831a7ba541b8625703600655a76/c850b081fba94992862572fa006013b9!OpenDocument.
External links
- Lymphoma Treatment: Watch and Wait
- Watchful Waiting and Monitoring Indolent Lymphomas
- Watchful Waiting: Chapter from Lymphoma Australia's "Your Journey Of Lymphoma Treatments" DVD
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