Watchful waiting

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Watchful waiting

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.

Contents

Related terms include expectant management, [1] [2] active surveillance (especially active surveillance of prostate cancer), [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:

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

Related Research Articles

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<span class="mw-page-title-main">Hernia</span> Abnormal exit of tissues or organs from the cavity they usually reside in

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<span class="mw-page-title-main">Orchiectomy</span> Surgical removal of one or both testicles

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<span class="mw-page-title-main">Active surveillance of prostate cancer</span>

Active surveillance is a management option for localized prostate cancer that can be offered to appropriate patients who would also be candidates for aggressive local therapies, with the intent to intervene if the disease progresses. Active surveillance should not be confused with watchful waiting, another observational strategy for men that would not be candidates for curative therapy because of a limited life expectancy. Active surveillance offers men with a prostate cancer that is thought to have a low risk of causing harm in the absence of treatment, a chance to delay or avoid aggressive treatment and its associated side effects.While prostate cancer is the most common non cutaneous cancer and second leading cause of cancer-related death in American men, it is conservatively estimated that approximately 100,000 men per year in the United States who would be eligible for conservative treatment through active surveillance, undergo unnecessary treatments. The management of localized prostate cancer is controversial and men with localized disease diagnosed today often undergo treatments with significant side effects that will not improve overall health outcomes. The 2011 NIH State-of-the-Science Conference Statement on the "Role of active surveillance in the management of men with localized prostate cancer" pointed out the many unanswered questions about observational strategies for prostate cancer that require further research and clarification. These included:

<span class="mw-page-title-main">Inguinal hernia surgery</span> Medical procedure

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Mark S. Soloway is a leading authority in urologic cancer, researcher, former departmental chair, medical professor and invitational lecturer. He served as chairman of the University of Miami Miller School of Medicine Department of Urology and is currently a professor at the Miller School of Medicine. Born in Cleveland, Soloway received his B.Sc. from Northwestern University in Chicago (1961–1964). He completed his M.D. and residency at Case Western Reserve University School of Medicine in Cleveland, Ohio (1964–1970). He completed a fellowship at the National Cancer Institute of the National Institute of Health in Bethesda, MD (1970–1972). Soloway has received numerous awards for his work as a researcher and teacher, These awards are American Urological Association's Gold Cystoscope award, Mosby Scholarship for Scholastic Excellence award (1967), North Central Section of American Urological Association Traveling Fellowship award (1972) and many others. These are outstanding achievements for an individual who has contributed most to the field of urology within ten years of completion of his residency program” (1984).

Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development, and is normally a component of an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam can also be conducted to verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities, urethral opening abnormalities, problems related to not being circumcised, lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues, and many others. In some instances where a physical examination of the male genitals is not sufficient to diagnose an individual, then an internal genital examination using imaging or ultrasounds will be needed for further evaluation.

The Scandinavian Prostate Cancer Group (SPCG) is a group of scientific researchers who have conducted a series of clinical trials of treatments for prostate cancer. The group was founded in 1981 and the first study, SPCG-1, began in 1984.

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