Aktueller Newsletter Februar

Stand: 3. März 2017
  1. Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis.

    mehr Informationen auf PubMed

    Related Articles

    J Eur Acad Dermatol Venereol. 2017 Feb 27;:

    Authors: Gisondi P, Altomare G, Ayala F, Bardazzi F, Bianchi L, Chiricozzi A, Costanzo A, Conti A, Dapavo P, De Simone C, Foti C, Naldi L, Offidani A, Parodi A, Piaserico S, Prignano F, Rongioletti F, Stingeni L, Talamonti M, Girolomoni G

    Abstract
    Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.

    PMID: 28244153 [PubMed - as supplied by publisher]

  2. Use of theory to plan or evaluate guideline implementation among physicians: a scoping review.

    mehr Informationen auf PubMed

    Implement Sci. 2017 Feb 27;12(1):26

    Authors: Liang L, Bernhardsson S, Vernooij RW, Armstrong MJ, Bussières A, Brouwers MC, Gagliardi AR, Members of the Guidelines International Network Implementation Working Group

    Abstract
    BACKGROUND: Guidelines support health care decision-making and high quality care and outcomes. However, their implementation is sub-optimal. Theory-informed, tailored implementation is associated with guideline use. Few guideline implementation studies published up to 1998 employed theory. This study aimed to describe if and how theory is now used to plan or evaluate guideline implementation among physicians.
    METHODS: A scoping review was conducted. MEDLINE, EMBASE, and The Cochrane Library were searched from 2006 to April 2016. English language studies that planned or evaluated guideline implementation targeted to physicians based on explicitly named theory were eligible. Screening and data extraction were done in duplicate. Study characteristics and details about theory use were analyzed.
    RESULTS: A total of 1244 published reports were identified, 891 were unique, and 716 were excluded based on title and abstract. Among 175 full-text articles, 89 planned or evaluated guideline implementation targeted to physicians; 42 (47.2%) were based on theory and included. The number of studies using theory increased yearly and represented a wide array of countries, guideline topics and types of physicians. The Theory of Planned Behavior (38.1%) and the Theoretical Domains Framework (23.8%) were used most frequently. Many studies rationalized choice of theory (83.3%), most often by stating that the theory described implementation or its determinants, but most failed to explicitly link barriers with theoretical constructs. The majority of studies used theory to inform surveys or interviews that identified barriers of guideline use as a preliminary step in implementation planning (76.2%). All studies that evaluated interventions reported positive impact on reported physician or patient outcomes.
    CONCLUSIONS: While the use of theory to design or evaluate interventions appears to be increasing over time, this review found that one half of guideline implementation studies were based on theory and many of those provided scant details about how theory was used. This limits interpretation and replication of those interventions, and seems to result in multifaceted interventions, which may not be feasible outside of scientific investigation. Further research is needed to better understand how to employ theory in guideline implementation planning or evaluation.

    PMID: 28241771 [PubMed - in process]

  3. Application of the Consolidated Framework for Implementation Research to assess factors that may influence implementation of tobacco use treatment guidelines in the Viet Nam public health care delivery system.

    mehr Informationen auf PubMed

    Implement Sci. 2017 Feb 28;12(1):27

    Authors: VanDevanter N, Kumar P, Nguyen N, Nguyen L, Nguyen T, Stillman F, Weiner B, Shelley D

    Abstract
    BACKGROUND: Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC.
    METHODS: We conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study.
    RESULTS: The interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting).
    CONCLUSIONS: In this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC.
    TRIAL REGISTRATION: NCT02564653 . Registered September 2015.

    PMID: 28241770 [PubMed - in process]

  4. Adherence to National Comprehensive Cancer Network guidelines for time to initiation of postoperative radiation therapy for patients with head and neck cancer.

    mehr Informationen auf PubMed

    Related Articles

    Cancer. 2017 Feb 27;:

    Authors: Graboyes EM, Garrett-Mayer E, Sharma AK, Lentsch EJ, Day TA

    Abstract
    BACKGROUND: Adherence to evidence-based treatment guidelines has been proposed as a measure of cancer care quality. The objective of this study was to determine the rate and predictors of care that does not adhere to National Comprehensive Cancer Network guidelines regarding commencing postoperative radiation therapy (PORT) within 6 weeks of surgery for patients with head and neck squamous cell carcinoma (HNSCC).
    METHODS: The National Cancer Data Base was reviewed from 2006 to 2014, and patients with HNSCC who underwent curative-intent surgery followed by PORT were identified. Multivariable logistic regression analysis was used to determine the factors associated with nonadherence to guidelines regarding the timing of initiating PORT.
    RESULTS: In total, 47,273 patients were included in the study. 55.7% of patients (26,340/47,273) failed to commence PORT within 6 week of surgery. The percentage of patients who failed to initiate PORT within 6 week of surgery increased over time. On multivariable analysis, the factors associated with failure to initiate timely, guideline-adherent PORT included black race, public insurance [Medicare, Medicaid] or uninsured status, lower levels of education, increased severity of comorbidity, increased postoperative length of stay, 30-day unplanned hospital readmission, treatment at an academic medical center, and the receipt of surgery and PORT at different facilities.
    CONCLUSIONS: Over 50% of patients with HNSCC who undergo surgery and PORT receive care that does not adhere to National Comprehensive Cancer Network guidelines with regard to initiating PORT within 6 weeks of surgery. Sociodemographic, oncologic, treatment, and hospital factors are all associated with failure to receive guideline-directed care and should be explored in future studies. Cancer 2017. © 2017 American Cancer Society.

    PMID: 28241092 [PubMed - as supplied by publisher]

  5. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017.

    mehr Informationen auf PubMed

    Radiology. 2017 Feb 23;:161659

    Authors: MacMahon H, Naidich DP, Goo JM, Lee KS, Leung AN, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis WD, Van Schil PE, Bankier AA

    Abstract
    The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. (©) RSNA, 2017 Online supplemental material is available for this article.

    PMID: 28240562 [PubMed - as supplied by publisher]

  6. The cost of a recalcitrant intravenous drug user with serial cases of endocarditis: Need for guidelines to improve the continuum of care.

    mehr Informationen auf PubMed

    Related Articles

    IDCases. 2017;8:3-5

    Authors: Libertin CR, Camsari UM, Hellinger WC, Schneekloth TD, Rummans TA

    Abstract
    We report a case of an intravenous drug user (IVDU) patient who had 4 episodes of endocarditis within a 2-year time period in rural Georgia. The institutional cost was approximately $380,000. The lack of an established transitional care plan for IVDUs to outpatient care is a common phenomenon at institutions. Guidelines are essential to optimize the quality of care rendered to IVDUs with such infections, to assist providers in utilizing limited resources, and to limit the cost to the institutions.

    PMID: 28239556 [PubMed - in process]

  7. Cost-effectiveness of a nurse-led intervention to optimise implementation of guideline-concordant continence care: Study protocol of the COCON study.

    mehr Informationen auf PubMed

    Related Articles

    BMC Nurs. 2017;16:10

    Authors: Jansen AP, Muntinga ME, Bosmans JE, Berghmans B, Dekker J, Hugtenburgh J, Nijpels G, van Houten P, Laurant MG, van der Vaart HC

    Abstract
    BACKGROUND: Guidelines on urinary incontinence recommend that absorbent products are only used as a coping strategy pending definitive treatment, as an adjunct to ongoing therapy, or for long-term management after all treatment options have been explored. However, these criteria are rarely met and a significant share of long-term product users could still benefit from therapeutic interventions recommended in guidelines for urinary incontinence. Better implementation of these guidelines can potentially result in both health benefits for women and long-term cost savings for society. The aim of the COCON study is to evaluate the (cost-)effectiveness of a nurse-led intervention to optimise implementation of guideline-concordant continence care in comparison with usual care for urinary incontinent women aged 55 years and over who use absorbent products.
    METHODS: This randomised clinical trial compares usual care with a nurse-led intervention to optimise implementation of guideline-concordant continence care. Women (anticipated N = 160) are recruited in 12 community pharmacies in three Dutch regions, and are eligible for trial entry when they are 55 years and over, community-dwelling and long-term users of absorbent products (≥4 months) reimbursed by health insurance. Measurements are administered at baseline, 3, 6 and 12 months. Primary outcome is severity of urinary incontinence (ICIQ-UI SF); other outcomes include health related quality of life (EQ-5D-5 L), use of absorbent products (in accordance with the recommended criteria in guidelines) (yes/no), and societal costs. Mixed model analysis will be performed to compare (the course) of outcomes between groups. The economic evaluation will be performed from a societal perspective. The implementation process is investigated using the Tailored Implementation for Chronic Diseases (TICD) framework.
    DISCUSSION: Results will add to current knowledge of the (cost-)effectiveness of nurse-led primary healthcare to improve guideline-concordant care for older women with urinary incontinence. In addition, the results will provide more insight into care needs and health service utilization of this group of women, as well as into use of absorbent products in accordance with the recommended criteria in guidelines. Finally, results will increase our understanding of the intervention's uptake and could provide useful insights for future dissemination and sustenance.
    TRIAL REGISTRATION: Dutch Trial Register NTR4396, registered 13-January-2014.

    PMID: 28239296 [PubMed]

  8. Guideline-adherent therapy for stroke prevention in atrial fibrillation in different health care settings: Results from RAMSES study.

    mehr Informationen auf PubMed

    Related Articles

    Eur J Intern Med. 2017 Feb 23;:

    Authors: Başaran Ö, Dogan V, Biteker M, Karadeniz FÖ, Tekkesin Aİ, Çakıllı Y, Türkkan C, Hamidi M, Demir V, Gürsoy MO, Öztürk MT, Aksan G, Seyis S, Ballı M, Alıcı MH, Bozyel S, Kırma C, Collaborators

    Abstract
    OBJECTIVE: No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies.
    METHODS: Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared.
    RESULTS: Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8±9.8 vs. 68.7±11.4years, p<0.001), had a lower socioeconomic status, had a higher CHA2DS2VASc and HASBLED scores (3.4±1.4 vs. 3.1±1.7, p<0.001 and 1.7±1.0 vs. 1.6±1.1, p<0.001 respectively), and had more comorbidities than patients treated in THs. Inappropriate oral anticoagulant use was more prevalent in SHs than THs (31.4% vs. 25.6%, p<0.001). When over- and undertreatment rates were compared among hospital types, overtreatment was more prevalent in THs (7.6% vs. 0.9%, p<0.001) while undertreatment was more common in SHs (30.5% vs. 17.9%, p<0.001).
    CONCLUSION: This study demonstrates the marked disparity between patient groups with AF presenting at SHs and THs. The use of guideline-recommended therapy is not adequate in either type of centre, overtreatment was more prevalent in THs and undertreatment was more prevalent in SHs.

    PMID: 28238569 [PubMed - as supplied by publisher]

  9. Effect of a Quality Improvement Program to Improve Guideline Adherence and Attainment of Clinical Standards in Dialysis Care: Report of Outcomes in Year 1.

    mehr Informationen auf PubMed

    Related Articles

    Nephron. 2017 Feb 25;:

    Authors: Youssouf S, Nache A, Wijesekara C, Middleton RJ, Lewis D, Shurrab AE, O'Riordan E, Lappin LP, O'Donoghue D, Kalra PA, Hegarty J

    Abstract
    BACKGROUND: Best practice in dialysis is synthesised in clear international guidelines. However, a large gap remains between the international guidelines and the actual delivery of care. In this paper, we report outcomes for the first year of a multifaceted dialysis improvement programme in our network.
    METHODS: One year collaborative involving 3 haemodialysis units and a peritoneal dialysis (PD) programme involving 299 dialysis patients. Each unit addressed a different indicator (unit A - catheter-related bloodstream infection [CRBSI], unit B - pre-dialysis blood pressure [BP], unit C - dialysis dose, unit D - anaemia) with a shared aim to match the top 10% in the UK. Tailored multifaceted approaches include a modified collaborative methodology with an aim, framework, driver diagram, learning sessions, facilitated meetings, plan-do-study-act cycles and continuous measurement. Analysis of outcomes, costings, erythropoietin stimulating agent and iron use, and safety culture attributes.
    RESULTS: Unit A reduced CRBSI from 2.65 to 0.5 per 1,000 catheter days (p = 0.02). Unit B improved attainment of target BP from 37.5 to 67.2% (p = 0.003). Unit C improved attainment of target urea reduction ratio from 75.8 to 91.4% (p = 0.04). PD unit D improved attainment of target haemoglobin from 45.5 to 62.7% (p = 0.01), with no significant change in the indicators in a non-intervention unit. Safety culture attributes improved. Costs associated with admission for fluid overload and infection, erythropoietin, iron and thrombokinase use decreased 36% (£415,620-£264,143).
    CONCLUSIONS: Units that took part in this collaborative improved guideline adherence compared both to their own pre-intervention performance and a non-intervention unit. Such multifaceted interventions are a useful methodology to improve dialysis care.

    PMID: 28237984 [PubMed - as supplied by publisher]

  10. Changing Current Practice in Urology: Improving Guideline Development and Implementation Through Stakeholder Engagement.

    mehr Informationen auf PubMed

    Related Articles

    Eur Urol. 2017 Feb 22;:

    Authors: MacLennan SJ, MacLennan S, Bex A, Catto JW, De Santis M, Glaser AW, Ljungberg B, N'Dow J, Plass K, Trapero-Bertran M, Van Poppel H, Wright P, Giles RH

    Abstract
    Effective stakeholder integration for guideline development should improve outcomes and adherence to clinical practice guidelines.

    PMID: 28237788 [PubMed - as supplied by publisher]

  11. Update of the Grupo Español de Leucemia Linfocítica Crónica clinical guidelines of the management of chronic lymphocytic leukemia.

    mehr Informationen auf PubMed

    Med Clin (Barc). 2017 Feb 21;:

    Authors: García-Marco JA, Delgado J, Hernández-Rivas JA, Ramírez Payer Á, Loscertales Pueyo J, Jarque I, Abrisqueta P, Giraldo P, Martínez R, Yáñez L, Terol MJ, González M, Bosch F, en nombre del Grupo Español de Leucemia Linfocítica Crónica (GELLC)

    Abstract
    BACKGROUND AND OBJECTIVE: The broad therapeutic arsenal and the biological heterogeneity of patients with chronic lymphocytic leukemia (CLL) makes it difficult to standardize treatment for CLL patients with specific clinical settings in routine clinical practice. These considerations prompted us to elaborate the present consensus document, which constitutes an update of the previous version published in 2013, mainly focusing on novel treatment strategies that have been developed over last 5 years, namely B-cell receptor inhibitors (ibrutinib and idelalisib), anti-CD20 monoclonal antibodies (ofatumumab and obinutuzumab), and Bcl-2 inhibitors (venetoclax).
    MATERIAL AND METHODS: A group of experts from the Spanish Chronic Lymphocytic Leukemia Group reviewed all published literature from January 2010 to January 2016, in order to provide recommendations based on clinical evidence. For those areas without strong scientific evidence, the panel of experts established consensus criteria based on their clinical experience.
    RESULTS: The project has resulted in several practical recommendations that will facilitate the diagnosis, treatment, and follow-up of patients with CLL.
    CONCLUSIONS: There are many controversial issues in the management of CLL with no appropriate studies for making consensus recommendations.

    PMID: 28236475 [PubMed - as supplied by publisher]

  12. Does enrollment in multidisciplinary team-based primary care practice improve adherence to guideline-recommended processes of care? Quebec's Family Medicine Groups, 2002-2010.

    mehr Informationen auf PubMed

    Related Articles

    Health Policy. 2017 Feb 13;:

    Authors: Diop M, Fiset-Laniel J, Provost S, Tousignant P, Borgès Da Silva R, Ouimet MJ, Latimer E, Strumpf E

    Abstract
    BACKGROUND: We investigated whether multidisciplinary team-based primary care practice improves adherence to process of care guidelines, in the absence of financial incentives related to pay-for-performance.
    METHODS: We conducted a natural experiment including 135,119 patients, enrolled with a general practitioner (GP) in a multidisciplinary team Family Medicine Group (FMG) or non-FMG practice, using longitudinal data from Quebec's universal insurer over the relevant time period (2000-2010). All study subjects had diabetes, chronic obstructive pulmonary disease, or heart failure and were followed over a 7-year period, 2 years prior to enrollment and 5 years after. We constructed indicators on adherence to disease-specific guidelines and composite indicators across conditions. We evaluated the effect of FMGs using propensity score methods and Difference-in-Differences (DD) models.
    RESULTS: Rates of adherence to chronic disease guidelines increased for both FMG and non-FMG patients after enrollment, but not differentially so. Adherence to prescription-related guidelines improved less for FMG patients (DD [95% CI]=-2.83% [-4.08%, -1.58%]). We found no evidence of an FMG effect on adherence to consultation-related guidelines, (DD [95% CI]=-0.24% [-2.24%; 1.75%]).
    CONCLUSIONS: We found no evidence that FMGs increased adherence to the guidelines we evaluated. Future research is needed to assess why this reform did not improve performance on these quality-of-care indicators.

    PMID: 28233598 [PubMed - as supplied by publisher]

  13. Quality Improvement in Concussion Care: Influence of Guideline-Based Education.

    mehr Informationen auf PubMed

    Related Articles

    J Pediatr. 2017 Feb 20;:

    Authors: Reisner A, Burns TG, Hall LB, Jain S, Weselman BC, De Grauw TJ, Ono KE, Blackwell LS, Chern JJ

    Abstract
    OBJECTIVE: To evaluate the potential impact of a concussion management education program on community-practicing pediatricians.
    STUDY DESIGN: We prospectively surveyed 210 pediatricians before and 18 months after participation in an evidence-based, concussion education program. Pediatricians were part of a network of 38 clinically integrated practices in metro-Atlanta. Participation was mandatory for at least 1 pediatrician in each practice. We assessed pediatricians' self-reported concussion knowledge, use of guidelines, and comfort level, as well as self-reported referral patterns for computed tomography (CT) and/or emergency department (ED) evaluation of children who sustained concussion.
    RESULTS: Based on responses from 120 pediatricians participating in the 2 surveys and intervention (response rate, 57.1%), the program had significant positive effects from pre- to postintervention on knowledge of concussions (-0.26 to 0.56 on -3 to +1 scale; P < .001), guideline use (0.73-.06 on 0-6 scale; P < .01), and comfort level in managing concussions (3.76-4.16 on 1-5 scale; P < .01). Posteducation, pediatricians were significantly less likely to self-report referral for CT (1.64-1.07; P < .001) and CT/ED (4.73-3.97; P < .01), but not ED referral alone (3.07-3.09; P = ns).
    CONCLUSIONS: Adoption of a multifaceted, evidence-based, education program translated into a positive modification of self-reported practice behavior for youth concussion case management. Given the surging demand for community-based youth concussion care, this program can serve as a model for improving the quality of pediatric concussion management.

    PMID: 28233546 [PubMed - as supplied by publisher]

  14. Updated evidence-based (S2e) European Dermatology Forum guideline on topical corticosteroids in pregnancy.

    mehr Informationen auf PubMed

    Related Articles

    J Eur Acad Dermatol Venereol. 2017 Feb 24;:

    Authors: Chi CC, Kirtschig G, Aberer W, Gabbud JP, Lipozenčić J, Kárpáti S, Haustein UF, Wojnarowska F, Zuberbier T

    Abstract
    BACKGROUND: Topical corticosteroids may be needed for treating skin conditions in pregnancy. Nevertheless, only limited data on the fetal effects of topical corticosteroids are available.
    OBJECTIVE: To update an evidence-based guideline on the safe use of topical corticosteroids in pregnancy.
    METHODS: A guideline subcommittee of the European Dermatology Forum updated the guideline by adding and appraising new evidence.
    RESULTS: The current best evidence from 14 observational studies with 1 601 515 study subjects found no significant associations between maternal use of topical corticosteroids of any potency and some adverse pregnancy outcomes including mode of delivery, birth defect, preterm delivery and fetal death. However, maternal use of potent/very potent topical corticosteroids, especially in large amounts, is associated with an increase in the risk of low birthweight.
    CONCLUSION: Mild/moderate topical corticosteroids should be preferred to potent/very potent ones in pregnancy. The well-known topical side-effects of corticosteroids on the mother's side need to be considered as well.

    PMID: 28233354 [PubMed - as supplied by publisher]

  15. Sustaining Guideline Implementation: A Multi-site Perspective on Activities, Challenges and Supports.

    mehr Informationen auf PubMed

    Related Articles

    J Clin Nurs. 2017 Feb 23;:

    Authors: Higuchi KS, Davies B, Ploeg J

    Abstract
    AIMS AND OBJECTIVES: To examine activities conducted, challenges encountered, and supports used when sustaining nursing practice guideline implementation in multiple health care organizations over three years.
    BACKGROUND: Numerous models and frameworks exist to guide the implementation of guidelines, yet very few focus on sustaining improved practice changes. It is not known if one intervention or multiple interventions are required, nor the long-term activities, challenges, and supports for sustaining improved practices.
    DESIGN: Qualitative descriptive study.
    METHODS: We conducted focus group interviews with steering committee members and individual interviews with leaders and direct care providers at the end of a three year guideline implementation study. The National Health Service Sustainability Model was used to guide data collection and analysis.
    RESULTS: The eight sites included three teaching hospitals, a community hospital, a long term care facility, two community health agencies, and a community health center. Individual interviews were conducted with 36 leaders and 26 direct care providers. Focus group interviews were conducted with steering committee members (n=70) at each site. Guideline implementation activities (n= 45) included developing new outcome monitoring systems, conducting chart audits, communicating progress to internal stakeholders, appointing interprofessional staff to steering committees, developing educational sessions and resources for staff and patients, revising policies and procedures, and developing partnerships with external organizations. Supports included lessons learned from previous and concurrent change initiatives, and commitment, involvement, and positive attitudes of staff and leaders.
    CONCLUSION: Activities identified by the participants addressed all 10 factors in the Sustainability Model in the three areas of process, staff, and organization. The challenges and supports encountered provide insights into the process of guideline implementation and sustainability. This article is protected by copyright. All rights reserved.

    PMID: 28231620 [PubMed - as supplied by publisher]

  16. Evidence based (S3) Guidelines for Diagnostics and treatment of venous leg ulcers - Answer to Dr Bertolini.

    mehr Informationen auf PubMed

    Related Articles

    J Eur Acad Dermatol Venereol. 2017 Feb 23;:

    Authors: Neumann M

    Abstract
    The differential diagnosis of a leg ulcer is broad with a great variety of diseases. Beside the well known as venous, arterial, mixed and diabetic most are rare. Prolidase deficiency is one of the rare causes.Nether the less it is an excellent suggestion to add also genetic diseases as prolidae deficiency to this Guideline. The committee will take this for the next revision.Martino Neumann, on behalf of the redaction of the EADF Guideline Diagnosis and Treatment of Venous Leg Ulcers This article is protected by copyright. All rights reserved.

    PMID: 28231377 [PubMed - as supplied by publisher]

  17. Benchmarking of venous thromboembolism prophylaxis practice with ENT.UK guidelines.

    mehr Informationen auf PubMed

    Related Articles

    Eur Arch Otorhinolaryngol. 2017 Feb 22;:

    Authors: Al-Qahtani AS

    Abstract
    The aim of this study was to benchmark our guidelines of prevention of venous thromboembolism (VTE) in ENT surgical population against ENT.UK guidelines, and also to encourage healthcare providers to utilize benchmarking as an effective method of improving performance. The study design is prospective descriptive analysis. The setting of this study is tertiary referral centre (Assir Central Hospital, Abha, Saudi Arabia). In this study, we are benchmarking our practice guidelines of the prevention of VTE in the ENT surgical population against that of ENT.UK guidelines to mitigate any gaps. ENT guidelines 2010 were downloaded from the ENT.UK Website. Our guidelines were compared with the possibilities that either our performance meets or fall short of ENT.UK guidelines. Immediate corrective actions will take place if there is quality chasm between the two guidelines. ENT.UK guidelines are evidence-based and updated which may serve as role-model for adoption and benchmarking. Our guidelines were accordingly amended to contain all factors required in providing a quality service to ENT surgical patients. While not given appropriate attention, benchmarking is a useful tool in improving quality of health care. It allows learning from others' practices and experiences, and works towards closing any quality gaps. In addition, benchmarking clinical outcomes is critical for quality improvement and informing decisions concerning service provision. It is recommended to be included on the list of quality improvement methods of healthcare services.

    PMID: 28229295 [PubMed - as supplied by publisher]

  18. [Real-time 3D echocardiography for estimation of severity in valvular heart disease : Impact on current guidelines].

    mehr Informationen auf PubMed

    Related Articles

    Herz. 2017 Feb 22;:

    Authors: Buck T, Bösche L, Plicht B

    Abstract
    Besides providing spatial anatomic information on heart valves, real-time three-dimensional echocardiography (3DE) combined with color Doppler has the potential to overcome the limitations of flow quantification inherent to conventional 2D color Doppler methods. Recent studies validated the application of color Doppler 3DE (cD-3DE) for the quantification of regurgitation flow based on the vena contracta area (VCA) and the proximal isovelocity surface area (PISA) methods. Particularly the assessment of VCA by cD-3DE led to a change of paradigm by understanding of the VCA as being strongly asymmetric in the majority of patients and etiologies. This review provides a comprehensive description of the different concepts of cD-3DE-based flow quantification in the setting of different valvular heart diseases and their presentation in recent guidelines.

    PMID: 28229203 [PubMed - as supplied by publisher]

  19. Delays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get With The Guidelines-Stroke.

    mehr Informationen auf PubMed

    Stroke. 2017 Feb 22;:

    Authors: Kamal N, Sheng S, Xian Y, Matsouaka R, Hill MD, Bhatt DL, Saver JL, Reeves MJ, Fonarow GC, Schwamm LH, Smith EE

    Abstract
    BACKGROUND AND PURPOSE: Despite quality improvement programs such as the American Heart Association/American Stroke Association Target Stroke initiative, a substantial portion of acute ischemic stroke patients are still treated with tissue-type plasminogen activator (alteplase) later than 60 minutes from arrival. This study aims to describe the documented reasons for delays and the associations between reasons for delays and patient outcomes.
    METHODS: We analyzed the characteristics of 55 296 patients who received intravenous alteplase in 1422 hospitals participating in Get With The Guidelines-Stroke from October 2012 to April 2015, excluding transferred patients and inpatient strokes. We assessed eligibility, medical, and hospital reasons for delays in door-to-needle time.
    RESULTS: There were 27 778 patients (50.2%) treated within 60 minutes, 10 086 patients (18.2%) treated >60 minutes without documented delays, and 17 432 patients (31.5%) treated >60 minutes with one or more documented reasons for delay. Delayed door-to-needle times were associated with delayed diagnosis (36 minutes longer than those without delay in diagnosis) and hypoglycemia or seizure (34 minutes longer than without those conditions). The presence of documented delays was associated with higher odds of in-hospital mortality (odds ratio, 1.2; 95% confidence interval, 1.1-1.3) and symptomatic intracranial hemorrhage (odds ratio, 1.2; 95% confidence interval, 1.1-1.3) and lower odds of independent ambulation at discharge (odds ratio, 0.92; 95% confidence interval, 0.9-1.0) after adjusting for patient and hospital characteristics.
    CONCLUSIONS: Hospital and eligibility delays such as delay diagnosis and inability to determine eligibility were associated with longer door-to-needle times. Improved stroke recognition and management of acute comorbidities may help to reduce door-to-needle times.

    PMID: 28228574 [PubMed - as supplied by publisher]

  20. The impact of changes in HIV management guidelines on time to treatment initiation in Australia.

    mehr Informationen auf PubMed

    Related Articles

    HIV Med. 2017 Feb 22;:

    Authors: Puhr R, Petoumenos K, Youds D, Law MG, Templeton DJ, Australian HIV Observational Database (AHOD) study group

    PMID: 28224755 [PubMed - as supplied by publisher]

  21. Erratum to: Brain Trauma Foundation Guidelines for Intracranial Pressure Monitoring: Compliance and Effect on Outcome.

    mehr Informationen auf PubMed

    Related Articles

    World J Surg. 2017 Feb 21;:

    Authors: Aiolfi A, Benjamin E, Khor D, Inaba K, Lam L, Demetriades D

    PMID: 28224197 [PubMed - as supplied by publisher]

  22. Development of a novel algorithm to determine adherence to chronic pain treatment guidelines using administrative claims.

    mehr Informationen auf PubMed

    Related Articles

    J Pain Res. 2017;10:327-339

    Authors: Margolis JM, Princic N, Smith DM, Abraham L, Cappelleri JC, Shah SN, Park PW

    Abstract
    OBJECTIVE: To develop a claims-based algorithm for identifying patients who are adherent versus nonadherent to published guidelines for chronic pain management.
    METHODS: Using medical and pharmacy health care claims from the MarketScan® Commercial and Medicare Supplemental Databases, patients were selected during July 1, 2010, to June 30, 2012, with the following chronic pain conditions: osteoarthritis (OA), gout (GT), painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), and fibromyalgia (FM). Patients newly diagnosed with 12 months of continuous medical and pharmacy benefits both before and after initial diagnosis (index date) were categorized as adherent, nonadherent, or unsure according to the guidelines-based algorithm using disease-specific pain medication classes grouped as first-line, later-line, or not recommended. Descriptive and multivariate analyses compared patient outcomes with algorithm-derived categorization endpoints.
    RESULTS: A total of 441,465 OA patients, 76,361 GT patients, 10,645 pDPN, 4,010 PHN patients, and 150,321 FM patients were included in the development of the algorithm. Patients found adherent to guidelines included 51.1% for OA, 25% for GT, 59.5% for pDPN, 54.9% for PHN, and 33.5% for FM. The majority (~90%) of patients adherent to the guidelines initiated therapy with prescriptions for first-line pain medications written for a minimum of 30 days. Patients found nonadherent to guidelines included 30.7% for OA, 6.8% for GT, 34.9% for pDPN, 23.1% for PHN, and 34.7% for FM.
    CONCLUSION: This novel algorithm used real-world pharmacotherapy treatment patterns to evaluate adherence to pain management guidelines in five chronic pain conditions. Findings suggest that one-third to one-half of patients are managed according to guidelines. This method may have valuable applications for health care payers and providers analyzing treatment guideline adherence.

    PMID: 28223842 [PubMed - in process]

  23. Implementation of the 2013 amended Patients' Rights Act in Norway: Clinical priority guidelines and access to specialised health care.

    mehr Informationen auf PubMed

    Related Articles

    Health Policy. 2017 Feb 20;:

    Authors: Johansson KA, Nygaard E, Herlofsen B, Lindemark F, Norwegian Clinical Priority Guidelines Author Group

    Abstract
    In 2013, the Norwegian Patient Rights' Act was amended in order to simplify the priority setting process for specialized elective health care and to improve access to care. As a result of the amendment, priority for treatment is now determined by only two criteria: 1) clinical effectiveness; and 2) cost-effectiveness of the intervention. There are 33 clinical priority-setting guidelines organised by medical specialty, which help hospitals evaluate whether individual patients have a right to access care. Following the amendment of the Patient Rights' Act, these guidelines had to be revised in order to assure coherence with the new legislation. The revised guidelines define and score a total of 556 condition-intervention pairs, and will give all patients who are evaluated as having a need for specialist elective healthcare the right to access these services. This is different from the old guidelines, where patients could be evaluated as having a need but no right for treatment. According to the new guidelines, a much larger share of patients will be granted a right to necessary specialist healthcare service (93% of condition-intervention pairs versus 77% of condition-intervention pairs in the old guidelines). One reason for this is that the severity of the condition is no longer considered as part of the evaluation process, which means that patients with low levels of severity now have a right to receive treatment. In addition, a new "don't do" list of 40 conditions was created, which may prevent unnecessary treatment.

    PMID: 28222905 [PubMed - as supplied by publisher]

  24. Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study.

    mehr Informationen auf PubMed

    Related Articles

    Int J Equity Health. 2017 Feb 10;16(1):32

    Authors: Teunissen E, Gravenhorst K, Dowrick C, Van Weel-Baumgarten E, Van den Driessen Mareeuw F, de Brún T, Burns N, Lionis C, Mair FS, O'Donnell C, O'Reilly-de Brún M, Papadakaki M, Saridaki A, Spiegel W, Van Weel C, Van den Muijsenbergh M, MacFarlane A

    Abstract
    BACKGROUND: Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice.
    METHODS: We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers' fieldwork reports, were coded and thematically analysed by each team using NPT.
    RESULTS: In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants' needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP's diagnoses and GPs reported a clearer understanding of migrants' symptoms.
    CONCLUSIONS: Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.

    PMID: 28222736 [PubMed - in process]

  25. Upper extremity sarcoma: impact of current practice guidelines and controversies on reconstructive approaches.

    mehr Informationen auf PubMed

    Related Articles

    SICOT J. 2017;3:15

    Authors: Dobke M, Mackert GA

    Abstract
    The goals of sarcoma management include both a cure and the functional preservation of involved tissues and adjacent critical structures with common opinions favoring immediate reconstruction. The question arises whether these goals are contradictory. This paper discusses the question based on the experience of 28 patients with different types of extremity sarcoma, with 24 surgically treated by the University of California San Diego (UCSD) orthopedic and plastic surgery team (2011-2016) and the collection of evidence from published practice guidelines, reviews, case studies, and clinical trials. Included are the impact of limb-sparing and functional reconstructive concepts, efforts regarding the adequacy of surgical margins, and the rationale of immediate versus delayed reconstructive approaches, and the disease-free status of sarcoma management.

    PMID: 28220751 [PubMed - in process]

  26. Several grain dietary patterns are associated with better diet quality and improved shortfall nutrient intakes in US children and adolescents: a study focusing on the 2015-2020 Dietary Guidelines for Americans.

    mehr Informationen auf PubMed

    Related Articles

    Nutr J. 2017 Feb 20;16(1):13

    Authors: Papanikolaou Y, Jones JM, Fulgoni VL

    Abstract
    BACKGROUND: The present study identified the most commonly consumed grain food patterns in US children and adolescents (2-18 years-old; N = 8,367) relative to those not consuming grains and compared diet quality and nutrient intakes, with focus on 2015-2020 Dietary Guidelines for Americans (2015-2020 DGA) shortfall nutrients.
    METHODS: Cluster analysis using data from the National Health and Nutrition Examination Survey 2005-2010, identified 8 unique grain food patterns: a) no consumption of main grain groups, b) cakes, cookies and pies, c) yeast bread and rolls, d) cereals, e) pasta, cooked cereals and rice, f) crackers and salty snacks, g) pancakes, waffles and French toast and other grains, and h) quick breads.
    RESULTS: Energy intake was higher for all grain cluster patterns examined, except 'cereals', compared to no grains. Children and adolescents in the 'yeast bread and rolls', 'cereals', 'pasta, cooked cereals and rice', and 'crackers and salty snacks' patterns had a higher diet quality relative to no grains (all p < 0.01). Energy adjusted (EA) dietary fiber intake was greater in five of the seven grain patterns, ranging from 1.8 - 2.8 g more per day (all p < 0.01), as compared to those consuming no grains. All grain patterns, except cakes, cookies and pies had higher EA daily folate relative to children in the no grains pattern (all p < 0.0001). EA total fat was lower in 'cereals', 'pasta, cooked cereals and rice', and 'pancakes, waffles, French toast and other grains' in comparison to the no grains food pattern (all p < 0.01). EA magnesium intakes were greater in children and adolescents consuming 'yeast bread and rolls', 'pasta, cooked cereals and rice', and 'quick breads', while EA iron was higher in all grain patterns relative to no grains (all p < 0.01). EA vitamin D intake was higher only in children consuming 'cereals' vs. no grain group (p < 0.0001). There were no significant differences in total or added sugar intake across all grain clusters as compared to no grains.
    CONCLUSIONS: Consumption of several, but not all, grain food patterns in children and adolescents were associated with improved 2015-2020 DGA shortfall nutrient intakes and diet quality as compared to those consuming no grains.

    PMID: 28219433 [PubMed - in process]

  27. Evaluation of the non-compliance with grouping guidelines which may lead to "wrong blood in tube", an observational study and risk factor analysis.

    mehr Informationen auf PubMed

    Related Articles

    Transfus Clin Biol. 2017 Feb 14;:

    Authors: Daurat A, Boudet E, Daurat G, Roger C, Gris JC, Tunez V, Gaste MC, Lefrant JY

    Abstract
    BACKGROUND: In France, blood group determination requires the completion of two samples collected at two different times to detect identity mistake and "wrong blood in tube". The aims of the present study were: (1) to evaluate the compliance with guidelines and (2) to identify risk factors of non-compliance.
    MATERIALS AND METHODS: Samples for ABO group determination collected between January 1st and December 15th, 2013 in the University hospital of Nîmes, France were analyzed. An ABO group determination demand was considered non-compliant if more than one tube arrived in the laboratory within ten minutes apart. Between May 1st and June 30th 2014, a self-administered questionnaire was offered to the nurses of the hospital on a random day for each service during this period. The aim was to validate the non-compliance criterion and the identification of risk factors using logistic regression.
    RESULTS: Among the 16,450 analyzed blood samples, the overall compliance rate was 65.1%. Lower compliance rates were found in the surgical services. Independent risk factors for wrong practice were work overload, surgical service and individual intermediate transfusion frequency.
    DISCUSSION: More than one third of ABO group determinations did not follow national recommendations, which induces a substantial risk of "wrong blood in tube" and group error. The study revealed major variations among hospital services. Identification of risk factors allows targeted corrective actions.

    PMID: 28214244 [PubMed - as supplied by publisher]

  28. Utah obstetricians' opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study.

    mehr Informationen auf PubMed

    Related Articles

    Birth. 2017 Feb 17;:

    Authors: Rainey E, Simonsen S, Stanford J, Shoaf K, Baayd J

    Abstract
    BACKGROUND: The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines.
    METHODS: Participants were recruited through online searches of Salt Lake City obstetricians and through snowball sampling. We conducted individual interviews exploring experiences with and attitudes toward planned home birth and the ACOG/NICE guidelines.
    RESULTS: Fifteen obstetricians who varied according to years of experience, location of medical training, sex, and subspecialty (resident, OB/GYN, maternal-fetal medicine specialist) were interviewed. Participants did not recommend home birth but supported a woman's right to choose her birth setting. Obstetrician opinions about planned home birth were shaped by misconceptions of home birth benefits, confusion surrounding the scope of care at home and among home birth providers, and negative transfer experiences. Participants were unfamiliar with the literature on planned home birth and/or viewed the evidence as unreliable. Support for ACOG guidelines was high, particularly in the context of the United States health care setting.
    CONCLUSION: Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth.

    PMID: 28211155 [PubMed - as supplied by publisher]

  29. Evaluation of AGA and Fukuoka Guidelines for EUS and surgical resection of incidental pancreatic cysts.

    mehr Informationen auf PubMed

    Related Articles

    Endosc Int Open. 2017 Feb;5(2):E116-E122

    Authors: Lee A, Kadiyala V, Lee LS

    Abstract
    Objectives Management of asymptomatic pancreatic cysts is challenging. Guidelines by the American Gastroenterological Association (AGA) and International Association of Pancreatology (Fukuoka) seek to identify high-risk patients. We assessed performance of these guidelines in selecting patients for endoscopic ultrasound (EUS) and/or surgery. Methods PART I - We retrospectively studied 143 asymptomatic cysts with magnetic resonance imaging (MRI) followed by EUS. Appropriate selection for EUS was defined as: malignant cytology or surgical pathology, or development of concerning features on MRI as defined by the guidelines. PART II - We retrospectively studied 152 resected cysts to assess the performance of guidelines in selecting cysts for surgery using malignant histology as the outcome. Results PART I - Of 143 EUS, 43 (30.1 %) were male with median age 65.0 years (interquartile range [IQR] 58.0 - 73.0). AGA guideline demonstrated lower sensitivity (17.6 % versus 35.3 %, P = 0.03), higher specificity (94.5 % versus 66.1 %, p < 0.001), and higher accuracy (76.2 % versus 58.7 %, P = 0.002) than Fukuoka. There was no difference in positive predictive value (50.0 % versus 24.5 %, P = 0.15) and negative predictive value (78.6 % versus 76.6 %, p=0.75). PART II - Of 152 resected cysts, 45 (29.8 %) were male with median age 59.0 years (IQR 47.3 - 66.7). There was no difference in performance characteristics of the guidelines in selecting cysts for surgery. AGA and Fukuoka guidelines missed 25.0 % and 18.8 % of malignant cysts, respectively (P = 1.00). Conclusions For referral to EUS, the AGA guideline was highly specific compared to Fukuoka; both suffered from poor sensitivity, although the Fukuoka guideline was relatively more sensitive than AGA. For referral to surgery, both guidelines have modest sensitivity and specificity and miss a similar percentage of malignant lesions.

    PMID: 28210708 [PubMed - in process]

  30. American Association for Emergency Psychiatry Task Force on Medical Clearance of Adults Part I: Introduction, Review and Evidence-Based Guidelines.

    mehr Informationen auf PubMed

    Related Articles

    West J Emerg Med. 2017 Feb;18(2):235-242

    Authors: Anderson EL, Nordstrom K, Wilson MP, Peltzer-Jones JM, Zun L, Ng A, Allen MH

    Abstract
    INTRODUCTION: In the United States, the number of patients presenting to the emergency department (ED) for a mental health concern is significant and expected to grow. The breadth of the medical evaluation of these patients is controversial. Attempts have been made to establish a standard evaluation for these patients, but to date no nationally accepted standards exist. A task force of the American Association of Emergency Psychiatry, consisting of physicians from emergency medicine and psychiatry, and a psychologist was convened to form consensus recommendations on the medical evaluation of psychiatric patients presenting to EDs.
    METHODS: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED (Part I) and then combined this with expert consensus (Part II).
    RESULTS: In Part I, we discuss terminological issues and existing evidence on medical exams and laboratory studies of psychiatric patients in the ED.
    CONCLUSION: Emergency physicians should work cooperatively with psychiatric receiving facilities to decrease unnecessary testing while increasing the quality of medical screening exams for psychiatric patients who present to EDs.

    PMID: 28210358 [PubMed - in process]

  31. Adherence to chronic kidney disease guidelines in primary care patients is associated with comorbidity.

    mehr Informationen auf PubMed

    Related Articles

    Fam Pract. 2017 Feb 16;:

    Authors: van Dipten C, van Berkel S, van Gelder VA, Wetzels JF, Akkermans RP, de Grauw WJ, Biermans MC, Scherpbier-de Haan ND, Assendelft WJ

    PMID: 28207923 [PubMed - as supplied by publisher]

  32. Are They Complying? Physicians' Knowledge, Attitudes, and Readiness to Change Regarding Low Back Pain Treatment Guideline Adherence.

    mehr Informationen auf PubMed

    Related Articles

    Spine (Phila Pa 1976). 2017 Feb 15;42(4):247-252

    Authors: Epstein-Sher S, Jaffe DH, Lahad A

    Abstract
    STUDY DESIGN: Cross-sectional survey of 145 primary care practitioners (PCPs).
    OBJECTIVE: To examine low back pain (LBP) guideline knowledge, readiness to implement (RTI) these guidelines, and LBP attitudes and beliefs among Israeli PCPs and determine whether physician age, guideline familiarity, and medical specialty affect these variables.
    SUMMARY OF BACKGROUND DATA: LBP is a common condition managed primarily by PCPs. Little is known, however, about physician's LBP knowledge, attitudes, and beliefs and how these factors (knowledge, A&B) influence their practice behavior. Knowledge, attitudes, and beliefs of PCPs have been shown to influence the course of their patients' LBP, and guidelines were devised in an attempt to improve the effectiveness and quality of LBP care. Research worldwide and in Israel has shown that LBP guideline implementation is not yet optimal.
    METHODS: Participants completed a questionnaire. Variables were measured using a translated, validated version of the Health Care Providers' Pain and Impairment Relationship Scale; demographic and professional characteristics were analyzed for correlation with the outcome variables.
    RESULTS: The likelihood of PCPs having nonguideline-consistent attitudes and beliefs (A&B) was greater among those older than 50 years (P < 0.05). Family medicine specialists (family practitioners [FPs]) were more likely to have a high level of guideline knowledge as compared to nonfamily medicine specialists (general practitioners (83.8 vs. 61.9, respectively; P < 0.001). Differences between FPs and general practitioners were also observed for the mean Health Care Providers' Pain and Impairment Relationship Scale score (34.6 vs. 41.1, respectively, P = 0.00), indicating a higher consistency of attitudes and beliefs with guidelines among FPs. No significant association was found between PCPs' knowledge level and RTI the guidelines.
    CONCLUSION: The present study showed that PCPs, especially FPs, had high levels of LBP guideline knowledge, although RTI was limited. The need for greater exposure to and understanding of the importance of implementation of LBP guidelines is essential for future guideline adherence.
    LEVEL OF EVIDENCE: 3.

    PMID: 28207666 [PubMed - in process]

  33. Appraising the methodological quality of the clinical practice guideline for diabetes mellitus using the AGREE II instrument: a methodological evaluation.

    mehr Informationen auf PubMed

    Related Articles

    JRSM Open. 2017 Feb;8(2):2054270416682673

    Authors: Radwan M, Akbari Sari A, Rashidian A, Takian A, Abou-Dagga S, Elsous A

    Abstract
    OBJECTIVES: To evaluate the methodological quality of the Palestinian Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II.
    DESIGN: Methodological evaluation. A cross-cultural adaptation framework was followed to translate and develop a standardised Translated Arabic Version of the AGREE II.
    SETTING: Palestinian Primary Healthcare Centres.
    PARTICIPANTS: Sixteen appraisers independently evaluated the Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II.
    MAIN OUTCOME MEASURES: Methodological quality of diabetic guideline.
    RESULTS: The Translated Arabic Version of the AGREE II showed an acceptable reliability and validity. Internal consistency ranged between 0.67 and 0.88 (Cronbach's α). Intra-class coefficient among appraisers ranged between 0.56 and 0.88. The quality of this guideline is low. Both domains 'Scope and Purpose' and 'Clarity of Presentation' had the highest quality scores (66.7% and 61.5%, respectively), whereas the scores for 'Applicability', 'Stakeholder Involvement', 'Rigour of Development' and 'Editorial Independence' were the lowest (27%, 35%, 36.5%, and 40%, respectively).
    CONCLUSIONS: The findings suggest that the quality of this Clinical Practice Guideline is disappointingly low. To improve the quality of current and future guidelines, the AGREE II instrument is extremely recommended to be incorporated as a gold standard for developing, evaluating or updating the Palestinian Clinical Practice Guidelines. Future guidelines can be improved by setting specific strategies to overcome implementation barriers with respect to economic considerations, engaging of all relevant end-users and patients, ensuring a rigorous methodology for searching, selecting and synthesising the evidences and recommendations, and addressing potential conflict of interests within the development group.

    PMID: 28203385 [PubMed - in process]

  34. International lessons in new methods for grading and integrating cost effectiveness evidence into clinical practice guidelines.

    mehr Informationen auf PubMed

    Related Articles

    Cost Eff Resour Alloc. 2017;15:1

    Authors: Antioch KM, Drummond MF, Niessen LW, Vondeling H

    Abstract
    Economic evidence is influential in health technology assessment world-wide. Clinical Practice Guidelines (CPG) can enable economists to include economic information on health care provision. Application of economic evidence in CPGs, and its integration into clinical practice and national decision making is hampered by objections from professions, paucity of economic evidence or lack of policy commitment. The use of state-of-art economic methodologies will improve this. Economic evidence can be graded by 'checklists' to establish the best evidence for decision making given methodological rigor. New economic evaluation checklists, Multi-Criteria Decision Analyses (MCDA) and other decision criteria enable health economists to impact on decision making world-wide. We analyse the methodologies for integrating economic evidence into CPG agencies globally, including the Agency of Health Research and Quality (AHRQ) in the USA, National Health and Medical Research Council (NHMRC) and Australian political reforms. The Guidelines and Economists Network International (GENI) Board members from Australia, UK, Canada and Denmark presented the findings at the conference of the International Health Economists Association (IHEA) and we report conclusions and developments since. The Consolidated Guidelines for the Reporting of Economic Evaluations (CHEERS) 24 item check list can be used by AHRQ, NHMRC, other CPG and health organisations, in conjunction with the Drummond ten-point check list and a questionnaire that scores that checklist for grading studies, when assessing economic evidence. Cost-effectiveness Analysis (CEA) thresholds, opportunity cost and willingness-to-pay (WTP) are crucial issues for decision rules in CEA generally, including end-of-life therapies. Limitations of inter-rater reliability in checklists can be addressed by including more than one assessor to reach a consensus, especially when impacting on treatment decisions. We identify priority areas to generate economic evidence for CPGs by NHMRC, AHRQ, and other agencies. The evidence may cover demand for care issues such as involved time, logistics, innovation price, price sensitivity, substitutes and complements, WTP, absenteeism and presentism. Supply issues may include economies of scale, efficiency changes, and return on investment. Involved equity and efficiency measures may include cost-of-illness, disease burden, quality-of-life, budget impact, cost-effective ratios, net benefits and disparities in access and outcomes. Priority setting remains essential and trade-off decisions between policy criteria can be based on MCDA, both in evidence based clinical medicine and in health planning.

    PMID: 28203120 [PubMed - in process]

  35. Is adherence to the Canadian 24-hour movement behaviour guidelines for school-aged children and youth associated with improved indicators of physical, mental, and social health?

    mehr Informationen auf PubMed

    Appl Physiol Nutr Metab. 2017 Feb 15;:

    Authors: Janssen I, Roberts KC, Thompson W

    Abstract
    The Canadian 24-Hour Movement Guidelines for Children and Youth were released in 2016. These guidelines contained recommendations for moderate-to-vigorous physical activity, screen time, and sleep duration. The objectives of this study were to determine: 1) whether achieving the individual recommendations and combinations of the recommendations within the guidelines is associated with indicators of physical, mental, and social health within children and youth; 2) whether meeting the recommendation for a specific movement behaviour is associated with larger differences in physical, mental, and social health indicators by comparison to meeting the recommendations for the other specific movement behaviours; and 3) whether physical, mental, and social health indicators differ according to different combinations of the guideline recommendations achieved. To address these objectives, we studied a representative sample of over 17,000 Canadians aged 10-17 years. The findings indicating that participants achieving any given recommendation had preferable scores for the health outcomes compared with participants who did not meet the recommendations. There was a dose-response pattern between the number of recommendations achieved and the health outcomes, indicating the health outcomes improved as more recommendations were achieved. When the number of recommendations achieved was the same, there were no differences in the health outcomes. For instance, health indicators scores were not different in the group who achieved the sleep and screen time recommendations, the group who achieved sleep and moderate-to-vigorous physical activity recommendations, and the group who achieved screen time and moderate-to-vigorous physical activity recommendations.

    PMID: 28199795 [PubMed - as supplied by publisher]

  36. Clinical pharmacogenetics implementation consortium (cpic) guideline for pharmacogenetics-guided warfarin dosing: 2017 update.

    mehr Informationen auf PubMed

    Related Articles

    Clin Pharmacol Ther. 2017 Feb 15;:

    Authors: Johnson JA, Caudle KE, Gong L, Whirl-Carrillo M, Stein CM, Scott SA, Lee MT, Gage BF, Kimmel SE, Perera MA, Anderson JL, Pirmohamed M, Klein TE, Limdi NA, Cavallari LH, Wadelius M

    Abstract
    This document is an update to the 2011 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2C9 and VKORC1 genotypes and warfarin dosing. Evidence from the published literature is presented for CYP2C9, VKORC1, CYP4F2, and rs12777823 genotype-guided warfarin dosing to achieve a target international normalized ratio of 2-3 when clinical genotype results are available. In addition, this updated guideline incorporates recommendations for adult and pediatric patients that are specific to continental ancestry. This article is protected by copyright. All rights reserved.

    PMID: 28198005 [PubMed - as supplied by publisher]

  37. ICUD guidelines for upper tract urothelial carcinoma: a state-of-the-art evidence-based guidance for clinical decisions regarding diagnosis, management and treatment.

    mehr Informationen auf PubMed

    Related Articles

    World J Urol. 2017 Mar;35(3):325-326

    Authors: Shariat SF

    PMID: 28197726 [PubMed - in process]

  38. [How do primary care physicians manage their patients with Helicobacter pylori infection? Results of a survey and their implementation into the German S2k guideline 2016].

    mehr Informationen auf PubMed

    Related Articles

    Z Gastroenterol. 2017 Feb;55(2):136-139

    Authors: Fischbach W, Zerl A, Klassert C

    Abstract
    Background The German S3 guideline "H. pylori and gastroduodenal ulcer disease" clearly recommends how to diagnose H. pylori infection. It also states when and how eradication therapy should be done. However, there are only few data available on the management of these patients in daily routine. With this survey, we wanted to gather information on how primary care physicians are involved in the management of H. pylori infection and how they follow the guideline recommendations. From this, consequences for the update of the new S2k guideline 2016 and their communication should be derived. Methods A questionnaire with 16 items was sent to all registered primary care physicians in the district of Unterfranken, Germany. Of the 607 questionnaires sent out, 188 (31 %) were returned. Results A test for H. pylori was induced in 76 % of cases with a history of ulcers, 66 % of dyspepsia, 55 % of a family history of gastric cancer, 54 % of unspecific abdominal discomfort, and 9 % and 6 % before initiating NSAID or ASS medication, respectively. Eighty-six percent of the physicians referred their patients to a gastroenterologist for further diagnostics, 45,8 % initiated eradication therapy by themselves, and 75 % and 25 % favored the French and Italian protocol, respectively. The majority did not consider a possible primary resistance to clarithromycine. Twenty-six percent did not regularly control the success of first-line eradication therapy. In case of control, the time intervals after end of eradication treatment are nearly always considered. Second-line therapy is initiated in 99 %, and its success is checked in 87 %. Conclusion Management of patients with H. pylori infection does not always follow the recommendations of current guidelines. The reasons for that were addressed in the formulation of the updated S2k guideline and will be communicated.

    PMID: 28192846 [PubMed - in process]

  39. Impact of an alternative chromosome 17 probe and the 2013 American Society of Clinical Oncology and College of American Pathologists guidelines on fluorescence in situ hybridization for the determination of HER2 gene amplification in breast cancer.

    mehr Informationen auf PubMed

    Related Articles

    Cancer. 2017 Feb 13;:

    Authors: Donaldson AR, Shetty S, Wang Z, Rivera CL, Portier BP, Budd GT, Downs-Kelly E, Lanigan CP, Calhoun BC

    Abstract
    BACKGROUND: The dual-probe fluorescence in situ hybridization (FISH) assay for human epidermal growth factor receptor 2 (HER2) gene amplification in breast cancer provides an HER2:CEP17 (centromere enumeration probe for chromosome 17) ratio. Copy number alteration (CNA) in CEP17 may skew this ratio. The authors analyzed the impact of the 2013 American Society of Oncology/College of American Pathologists (ASCO/CAP) guidelines and an alternative chromosome 17 probe on HER2 status in tumor specimens with CEP17 CNA.
    METHODS: Specimens with CEP17 CNA (n = 310) were selected from 3048 tumor samples that were received from January 2013 to June 2015 for testing with the alternative chromosome 17 probe D17S122. Reclassification of HER2 status was assessed using the 2007 and 2013 ASCO/CAP guidelines.
    RESULTS: The alternative chromosome 17 probe reclassified 82 of 310 (26.5%) and 87 of 310 (28.1%) tumors using the 2007 and 2013 guidelines, respectively. Of the 41 of 310 tumors (13.2%) that were reclassified from nonamplified to amplified according to 2007 guidelines, 28 of 41 (68.3%) had an average HER2 copy number ≥4.0 and <6.0. The 39 of 310 tumors (12.6%) that were reclassified from equivocal to amplified according to 2013 guidelines had a mean HER2 copy number between ≥4.0 and <6.0. Most of these patients had stage I, hormone receptor-positive, lymph node-negative tumors, which is an unusual clinicopathologic profile for HER2-amplified tumors, and most received HER2-targeted therapy in addition to endocrine therapy.
    CONCLUSIONS: Reflex testing with an alternative chromosome 17 probe using the 2013 ASCO/CAP guidelines reclassified 28.1% of tumor samples that had CEP17 CNA, converting nearly one-half from equivocal to amplified. The benefit of HER2-targeted therapy in this patient population requires further study. Cancer 2017. © 2017 American Cancer Society.

    PMID: 28192599 [PubMed - as supplied by publisher]

  40. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis.

    mehr Informationen auf PubMed

    Related Articles

    J Sex Med. 2017 Feb 08;:

    Authors: Gross MS, Phillips EA, Carrasquillo RJ, Thornton A, Greenfield JM, Levine LA, Alukal JP, Conners WP, Glina S, Tanrikut C, Honig SC, Becher EF, Bennett NE, Wang R, Perito PE, Stahl PJ, Rosselló Gayá M, Rosselló Barbará M, Cedeno JD, Gheiler EL, Kalejaiye O, Ralph DJ, Köhler TS, Stember DS, Carrion RE, Maria PP, Brant WO, Bickell MW, Garber BB, Pineda M, Burnett AL, Eid JF, Henry GD, Munarriz RM

    Abstract
    INTRODUCTION: Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines.
    AIM: To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections.
    METHODS: This retrospective institutional review board-exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device.
    MAIN OUTCOME MEASURES: Intraoperative culture data from infected IPPs.
    RESULTS: Two hundred twenty-seven intraoperative cultures (2002-2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation.
    CONCLUSION: This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;XX:XXX-XXX.

    PMID: 28189561 [PubMed - as supplied by publisher]

  41. Adherence to vaccination guidelines post splenectomy: A five year follow up study.

    mehr Informationen auf PubMed

    Related Articles

    J Infect Public Health. 2017 Feb 08;:

    Authors: Boam T, Sellars P, Isherwood J, Hollobone C, Pollard C, Lloyd DM, Dennison AR, Garcea G

    Abstract
    Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients.

    PMID: 28189514 [PubMed - as supplied by publisher]

  42. [Erratum to: Guideline-oriented inpatient psychiatric psychotherapeutic/psychosomatic treatment of anxiety disorders. How many personnel are need?]

    mehr Informationen auf PubMed

    Related Articles

    Nervenarzt. 2017 Feb 10;:

    Authors: Bandelow B, Lueken U, Wolff J, Godemann F, Wolff-Menzler C, Deckert J, Ströhle A, Beutel M, Wiltink J, Domschke K, Berger M

    PMID: 28188399 [PubMed - as supplied by publisher]

  43. Brain Trauma Foundation Guidelines for Intracranial Pressure Monitoring: Compliance and Effect on Outcome.

    mehr Informationen auf PubMed

    Related Articles

    World J Surg. 2017 Feb 10;:

    Authors: Aiolfi A, Benjamin E, Khor D, Inaba K, Lam L, Demetriades D

    Abstract
    BACKGROUND: Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring in patients who sustained severe traumatic brain injury (TBI). Compliance to BTF guidelines is variable, and the effect of ICP monitoring on outcomes remains a controversial issue. The purpose of this study was to assess guidelines compliance in patients who sustain a severe TBI and to analyze the effect of ICP monitoring on outcomes.
    METHODS: Trauma Quality Improvement Program database study, which included patients with isolated severe blunt head trauma (head Abbreviated Injury Scale ≥3 with Glasgow Coma Scale <9). Patients with severe extracranial injuries excluded. Analyzed variables were demographics, comorbidities, mechanism of injuries, head injury specifics, AIS for each body area, Injury Severity Score, admission vital signs, placement of ICP catheter and craniectomy. Multivariate analysis was used to identify independent predictors for outcomes, overall and in the groups of patients with head AIS 3, 4 or 5.
    RESULTS: During the study period 13,188 patients with isolated severe TBI met the BTF guidelines for ICP monitoring. An ICP catheter was placed in 1519 (11.5%) patients. Stepwise logistic regression analysis identified age ≥65 years, hypotension on admission, AIS 4 and AIS 5 as independent predictors for mortality. ICP monitoring was not an independent protective variable in terms of mortality (OR 1.12; 95% CI, 0.983-1.275; p = 0.088). Overall, ICP monitor placement was independently associated with increased overall complications (OR 2.089; 95% CI, 1.85-2.358; p < 0.001), infectious complications (OR 2.282; 95% CI, 2.015-2.584; p < 0.001) and poor functional independence (OR 1.889; 95% CI, 1.575-2.264; p < 0.001). Sub analysis of the groups of patients with head AIS 3, 4, and 5 failed to show any protective effect of ICP monitors against mortality. In the group of patients with head AIS 4, ICP placement was an independent predictor of mortality (OR 2206; 95% CI, 1652-2948; p < 0.001).
    CONCLUSIONS: Compliance with the BTF guidelines for ICP monitoring is poor. ICP monitoring does not have any survival benefit in patients with isolated severe blunt TBI and is associated with more complications and increased utilization of hospital resources.

    PMID: 28188356 [PubMed - as supplied by publisher]

  44. ESPACOMP Medication Adherence Reporting Guidelines (EMERGE): a reactive-Delphi study protocol.

    mehr Informationen auf PubMed

    Related Articles

    BMJ Open. 2017 Feb 10;7(2):e013496

    Authors: Helmy R, Zullig LL, Dunbar-Jacob J, Hughes DA, Vrijens B, Wilson IB, De Geest S

    Abstract
    INTRODUCTION: Medication adherence is fundamental to achieving optimal patient outcomes. Reporting research on medication adherence suffers from some issues-including conceptualisation, measurement and data analysis-that thwart its advancement. Using the ABC taxonomy for medication adherence as the conceptual basis, a steering committee of members of the European Society for Patient Adherence, COMpliance, and Persistence (ESPACOMP) launched an initiative to develop ESPACOMP Medication Adherence Reporting Guidelines (EMERGE). This paper is a protocol for a Delphi study that aims to build consensus among a group of topic experts regarding an item list that will support developing EMERGE.
    METHODS AND ANALYSIS: This study uses a reactive-Delphi design where a group of topic experts will be asked to rate the relevance and clarity of an initial list of items, in addition to suggesting further items and/or modifications of the initial items. The initial item list, generated by the EMERGE steering committee through a structured process, consists of 26 items distributed in 2 sections: 4 items representing the taxonomy-based minimum reporting criteria, and 22 items organised according to the common reporting sections. A purposive sample of experts will be selected from relevant disciplines and diverse geographical locations. Consensus will be achieved through predefined decision rules to keep, delete or modify the items. An iterative process of online survey rounds will be carried out until consensus is reached.
    ETHICS AND DISSEMINATION: An ethics approval was not required for the study according to the Swiss federal act on research involving human beings. The participating experts will be asked to give an informed consent. The results of this Delphi study will feed into EMERGE, which will be disseminated through peer-reviewed publications and presentations at conferences. Additionally, the steering committee will encourage their endorsement by registering the guidelines at the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network and other relevant organisations.

    PMID: 28188154 [PubMed - in process]

  45. Adherence to treatment guidelines: the association between stroke risk stratified comparing CHADS2 and CHA2DS2-VASc score levels and warfarin prescription for adult patients with atrial fibrillation.

    mehr Informationen auf PubMed

    Related Articles

    BMC Health Serv Res. 2017 Feb 11;17(1):127

    Authors: Chapman SA, St Hill CA, Little MM, Swanoski MT, Scheiner SR, Ware KB, Lutfiyya MN

    Abstract
    BACKGROUND: Ischemic stroke is a risk associated with atrial fibrillation (AF) and is estimated to occur five times more often in afflicted patients than in those without AF. Anti-thrombotic therapy is recommended for the prevention of ischemic stroke. Risk stratification tools, such as the CHADS2, and more recently the CHA2DS2-VASc, for predicting stroke in patients with AF have been developed to determine the level of stroke risk and assist clinicians in the selection of antithrombotic therapy. Warfarin, for stroke prevention in AF, is the most commonly prescribed anticoagulant in North America. The purpose of this study was to examine the utility of using the CHADS2 score levels (low and high) in contrast to the CHA2DS2-VASc when examining the outcome of warfarin prescriptions for adult patients with AF. The CHA2DS2-VASc tool was not widely used in 2010, when the data analyzed were collected. It has only been since 2014 that CHA2DS2-VASc criteria has been recommended to guide anticoagulant treatment in updated AF treatment guidelines.
    METHODS: Bivariate and multivariate data analysis strategies were used to analyze 2010 National Ambulatory Care Survey (NAMCS) data. NAMCS is designed to collect data on the use and provision of ambulatory care services nationwide. The study population for this research was US adults with a diagnosis of AF. Warfarin prescription was the dependent variable for this study. The study population was 7,669,844 AF patients.
    RESULTS: Bivariate analysis revealed that of those AF patients with a high CHADS2 score, 25.1% had received a warfarin prescription and 18.8 for those with a high CHA2DS2-VASc score. Logistic regression analysis yielded that patients with AF had higher odds of having a warfarin prescription if they had a high CHADS2 score, were Caucasian, lived in a zip code where < 20% of the population had a university education, and lived in a zip code where < 10% of the population were living in households with incomes below the federal poverty level. Further, the analysis yielded that patients with AF had lesser odds of having a warfarin prescription if they were ≥ 65 years of age, female, or had health insurance.
    CONCLUSIONS: Overall, warfarin appears to be under-prescribed for patients with AF regardless of the risk stratification system used. Based on the key findings of our study opportunities for interventions are present to improve guideline adherence in alignment with risk stratification for stroke prevention. Interprofessional health care teams can provide improved medical management of stroke prevention for patients with AF. These interprofessional health care teams should be constituted of primary care providers (physicians, physician assistants, and nurse practitioners), nurses (RN, LPN), and pharmacists (PharmD, RPh).

    PMID: 28187730 [PubMed - in process]

  46. [ESC-Guidelines 2016 - Prevention of Cardiovascular Diseases in Clinical Practice].

    mehr Informationen auf PubMed

    Related Articles

    Dtsch Med Wochenschr. 2017 Feb;142(3):189-192

    Authors: Wienbergen H, Hambrecht R

    PMID: 28187483 [PubMed - in process]

  47. [Hospital Antibiotic Stewardship - New Guidelines and New Findings].

    mehr Informationen auf PubMed

    Related Articles

    Dtsch Med Wochenschr. 2017 Feb;142(3):177-182

    Authors: de With K, Wilke K, Först G, Kramme E, Kern WV

    PMID: 28187481 [PubMed - in process]

  48. Predictors Of Failure To Respond To Fluid Restriction In Siad In Clinical Practice; Time To Re-Evaluate Clinical Guidelines?

    mehr Informationen auf PubMed

    Related Articles

    QJM. 2017 Feb 10;:

    Authors: Cuesta MI, Ortol Aacute A, Garrahy A, Luis Calle Pascual A, Runkle I, Thompson CJ

    PMID: 28186579 [PubMed - as supplied by publisher]

  49. [The significance and effect of guidelines 2. Observations concerning validation and recommendations with respect to guidelines].

    mehr Informationen auf PubMed

    Ned Tijdschr Tandheelkd. 2017 Feb;124(2):69-74

    Authors: Craandijk J

    Abstract
    The proper functioning of guidelines depends in part on correct validation. Validation requires an established norm. The professional and proto-pro-fessional paradigm uses different standards for validation based on different epistemological assumptions. Several different fundamental principles are also applied among healthcare professionals themselves. This leads to an insurmountable methodological difference whereby validation is not possible or meaningful at the moment. An important role seems reserved for the epistemology of the humanities to explain and interpret the guidelines. In addition, the operationalization of guidelines does not seem to be straightforward. The use of guidelines shows that unintended effects, such as the exclusion of patients from insurance and reimbursement, arise. In addition the number of guidelines is increasing to such an extent that implementation and enforcement are in danger of being compromised. Recommendations are made to monitor the significance and effect of guidelines.

    PMID: 28186510 [PubMed - in process]

  50. Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guideline From the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology.

    mehr Informationen auf PubMed

    Related Articles

    J Mol Diagn. 2017 Mar;19(2):187-225

    Authors: Sepulveda AR, Hamilton SR, Allegra CJ, Grody W, Cushman-Vokoun AM, Funkhouser WK, Kopetz SE, Lieu C, Lindor NM, Minsky BD, Monzon FA, Sargent DJ, Singh VM, Willis J, Clark J, Colasacco C, Rumble RB, Temple-Smolkin R, Ventura CB, Nowak JA

    Abstract
    OBJECTIVES: To develop evidence-based guideline recommendations through a systematic review of the literature to establish standard molecular biomarker testing of colorectal cancer (CRC) tissues to guide epidermal growth factor receptor (EGFR) therapies and conventional chemotherapy regimens.
    METHODS: The American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology convened an expert panel to develop an evidence-based guideline to establish standard molecular biomarker testing and guide therapies for patients with CRC. A comprehensive literature search that included more than 4,000 articles was conducted.
    RESULTS: Twenty-one guideline statements were established.
    CONCLUSIONS: Evidence supports mutational testing for EGFR signaling pathway genes, since they provide clinically actionable information as negative predictors of benefit to anti-EGFR monoclonal antibody therapies for targeted therapy of CRC. Mutations in several of the biomarkers have clear prognostic value. Laboratory approaches to operationalize CRC molecular testing are presented. Key Words: Molecular diagnostics; Gastrointestinal; Histology; Genetics; Oncology.

    PMID: 28185757 [PubMed - in process]

  51. Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government.

    mehr Informationen auf PubMed

    Related Articles

    J Public Health (Oxf). 2017 Feb 10;:1-7

    Authors: Kelly MP, Atkins L, Littleford C, Leng G, Michie S

    PMID: 28184452 [PubMed - as supplied by publisher]

  52. Coexistent Sickle Cell Disease Has No Impact on the Safety or Outcome of Lytic Therapy in Acute Ischemic Stroke: Findings From Get With The Guidelines-Stroke.

    mehr Informationen auf PubMed

    Related Articles

    Stroke. 2017 Mar;48(3):686-691

    Authors: Adams RJ, Cox M, Ozark SD, Kanter J, Schulte PJ, Xian Y, Fonarow GC, Smith EE, Schwamm LH

    Abstract
    BACKGROUND AND PURPOSE: The recommended treatment for ischemic stroke is tPA (tissue-type plasminogen activator). Although sickle cell disease (SCD) represents no known contraindication to tPA, National Heart Lung and Blood Institute of the National Institutes of Health recommended acute exchange transfusion for stroke in SCD, not tPA. Data on safety and outcomes of tPA in patients are needed to guide tPA use in SCD.
    METHODS: We matched patients from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke registry with SCD to patients without SCD and compared usage, complications, and discharge outcomes after tPA. Multivariable logistic regression models using generalized estimating equations were used to assess outcomes.
    RESULTS: From 2 016 652 stroke patients admitted to Get With The Guidelines-Stroke sites in the United States, 832 SCD and 3328 non-SCD controls with no differences in admission National Institutes of Health Stroke Scale or blood pressure were identified. Neither the fraction receiving thrombolytic therapy (8.2% for SCD versus 9.4% non-SCD) nor symptomatic intracranial hemorrhage (4.9% of SCD versus 3.2% non-SCD; P=0.4502) was different. There was no difference in a prespecified set of outcome measures for those with SCD compared with controls.
    CONCLUSIONS: Coexistent SCD had no significant impact on the safety or outcome of thrombolytic therapy in acute ischemic stroke. Although the sample size is relatively small, these data suggest that adults with SCD and acute ischemic stroke should be treated with thrombolysis, if they otherwise qualify. Addition studies, however, should track the intracranial hemorrhage rate and provide information on other SCD-related care such as transfusion.

    PMID: 28183857 [PubMed - in process]

  53. Poor adherence to management guidelines in nontuberculous mycobacterial pulmonary diseases.

    mehr Informationen auf PubMed

    Related Articles

    Eur Respir J. 2017 Feb;49(2):

    Authors: van Ingen J, Wagner D, Gallagher J, Morimoto K, Lange C, Haworth CS, Floto RA, Adjemian J, Prevots DR, Griffith DE, NTM-NET

    PMID: 28182571 [PubMed - in process]

  54. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease.

    mehr Informationen auf PubMed

    Related Articles

    Pediatr Surg Int. 2017 Feb 08;:

    Authors: Langer JC, Rollins MD, Levitt M, Gosain A, Torre L, Kapur RP, Cowles RA, Horton J, Rothstein DH, Goldstein AM, American Pediatric Surgical Association Hirschsprung Disease Interest Group

    Abstract
    Although most children with Hirschsprung disease ultimately do well, many experience a variety of ongoing problems after pull-through surgery. The most common include obstructive symptoms, soiling, enterocolitis and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative obstructive symptoms in children with Hirschsprung disease. The American Pediatric Surgical Association Board of Governors established a Hirschsprung Disease Interest Group. Group discussions, literature review and expert consensus were then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with obstructive symptoms following pull-through for Hirschsprung disease. Causes of obstructive symptoms post-pull-through include mechanical obstruction; persistent or acquired aganglionosis, hypoganglionosis, or transition zone pull-through; internal sphincter achalasia; disordered motility in the proximal intestine that contains ganglion cells; or functional megacolon caused by stool-holding behavior. An algorithm for the diagnosis and management of obstructive symptoms after a pull-through for Hirschsprung disease is presented. A stepwise, logical approach to the diagnosis and management of patients experiencing obstructive symptoms following pull-through for Hirschsprung disease can facilitate treatment. Level of evidence V.

    PMID: 28180937 [PubMed - as supplied by publisher]

  55. German Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders.

    mehr Informationen auf PubMed

    Related Articles

    Eur Addict Res. 2017;23(1):45-60

    Authors: Mann K, Batra A, Fauth-Bühler M, Hoch E, and the Guideline Group

    Abstract
    Evidence-based strategies for screening, diagnosing and treating alcohol use disorders (AUD) are instrumental in the early and better management of individuals at risk for or suffering from AUD. However, existing guidelines vary and may be biased by conflicts of interests. Unbiased recommendations can be achieved only if sufficient detail is provided on the composition and representativeness of author groups, methodological rigor, handling of potential conflicts of interest and financing. This paper presents the first evidence-based guidelines for AUD from German-speaking countries. These guidelines are based on the work of delegates from a representative sample of 46 scientific societies (mostly medical) from Austria, Germany and Switzerland dealing with AUD. It also included patients and relatives. Recommendations were derived from a standardised hierarchical process involving quality controls drawn from existing guidelines, de novo literature searches and/or expert experience. Potential conflicts of interest were assessed yearly and led to exclusion from voting in specific areas. An overall cost of more than 400,000€ (for alcohol and tobacco guidelines) were exclusively covered by the participating societies and academic institutions. More than 100 recommendations on screening, diagnostics and treatment of AUD are outlined in this paper, and their scientific background is given in the online supplementary material. Tables of aggregated study synopses (in English) and the full version of guidelines (in German) are available (see "Links").

    PMID: 28178695 [PubMed - in process]

  56. Are Standardized Test Guidelines Adequate for Assessing Waterborne Particulate Contaminants?

    mehr Informationen auf PubMed

    Related Articles

    Environ Sci Technol. 2017 Feb 21;51(4):1948-1950

    Authors: Khan FR, Syberg K, Palmqvist A

    PMID: 28177624 [PubMed - in process]

  57. Conflict between diabetes guidelines and experienced counselling in sports and physical activity. An exploratory study.

    mehr Informationen auf PubMed

    Related Articles

    Eur J Public Health. 2017 Feb 01;27(1):157-159

    Authors: Stuij M, Elling A, Abma TA

    PMID: 28177436 [PubMed - in process]

  58. DCIS and axillary nodal evaluation: compliance with national guidelines.

    mehr Informationen auf PubMed

    Related Articles

    BMC Surg. 2017 Feb 07;17(1):12

    Authors: Mitchell KB, Lin H, Shen Y, Colfry A, Kuerer H, Shaitelman SF, Babiera GV, Bedrosian I

    Abstract
    BACKGROUND: The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) provide guidelines regarding axillary nodal evaluation in ductal carcinoma in situ (DCIS), but data regarding national compliance with these guidelines remains incomplete.
    METHODS: We conducted a retrospective review of the National Cancer Data Base (NCDB) analyzing all surgical approaches to axillary evaluation in patients with DCIS. Logistic regression analysis was used to assess the multivariate relationship between patient demographics, clinical characteristics, and probability of axillary evaluation.
    RESULTS: We identified 88,083 patients diagnosed with DCIS between 1998 and 2011; 31,912 (37%) underwent total mastectomy (TM) and 55,349 (63%) had breast conserving therapy (BCT). Axillary evaluation increased from 44.4% in 1998 to 63.3% in 2011. In TM patients, axillary evaluation increased from 74.3% in 1998 to 93.4% in 2011. This correlated with an increase in sentinel lymph node biopsy (SLNB) from 24.3 to 77.1%, while ALND decreased from 50.0 to 16.3% (p <0.01). In BCT patients, evaluation increased from 20.1 to 43.9%; SLNB increased from 7.2 to 39.4% and ALND decreased from 12.9 to 4.5%. Factors associated with axillary nodal evaluation in BCT patients included practice type and facility location. Among TM patients, use of axillary lymph node dissection (ALND) for axillary staging was associated with earlier year of diagnosis, black race, and older age, as well as community practice setting and practice location in the Southern US.
    CONCLUSIONS: Compliance with national guidelines regarding axillary evaluation in DCIS remains varied. Practice type and location-based differences suggest opportunities for education regarding the appropriate use of axillary nodal evaluation in patients with DCIS.

    PMID: 28173790 [PubMed - indexed for MEDLINE]

  59. Novel Use of Twitter to Disseminate and Evaluate Adherence with Clinical Guidelines by the European Association of Urology.

    mehr Informationen auf PubMed

    Related Articles

    BJU Int. 2017 Feb 07;:

    Authors: Loeb S, Roupret M, Van Oort I, N'dow J, Van Gurp M, Bloemberg J, Darraugh JA, Ribal M

    Abstract
    The European Association of Urology was the first scientific association to systematically convert the clinical guidelines into social media posts for dissemination through twitter. Posts were classified using the hashtag #eauguidelines and each post was <140 characters which is the limit for twitter. The goals of this project were to increase dissemination of the guidelines, and to test adherence with guidelines recommendations through a series of twitter based-polls. During the first 18 months of this project (January 2015 - June 2016), there were 8,709 posts about the guidelines, with a total reach of 9,117,746 impressions. During the past 6 months, a total of 16 polls have been conducted asking whether participants practice in accordance with a specific guideline recommendation. These polls have had an average of 126 participants and average reach of 3013 impressions. Adherence with the guideline recommendations has ranged from 13 to 92% across polls. Herein, we demonstrate a proof-of-principal study on the use of twitter© as a platform for the dissemination and real-time evaluation of clinical guidelines. These strategies should be considered by other professional societies to increase the reach and obtain rapid feedback on guidelines recommendations. This article is protected by copyright. All rights reserved.

    PMID: 28170154 [PubMed - as supplied by publisher]

  60. Effect of an Asthma Guideline in 2 Pediatric Emergency Departments and an Urgent Care Center.

    mehr Informationen auf PubMed

    Related Articles

    Pediatr Emerg Care. 2017 Feb 04;:

    Authors: Dilts JJ, Humiston SG, Lee BR, Allen NH, Michael JG

    Abstract
    OBJECTIVES: The objective of this study was to evaluate ordering of albuterol via metered-dose inhaler with spacer (MDI-spacer), length of stay (LOS), and 72-hour return rates before and after publication of an internally developed pediatric asthma clinical practice guideline (CPG).
    METHODS: The internally developed CPG reflected national recommendations. It was explained at faculty meetings by a respected clinician and published on the intranet on February 6, 2012. We performed a retrospective study of visits from January 1, 2009, to October 31, 2014, by children aged 2 to 17 years with a primary diagnosis of asthma and discharged from a target site (2 pediatric emergency departments and 1 urgent care center). We excluded critical/emergent visits and those by patients who transferred to the emergency department/urgent care center from another facility or were admitted. We extracted data for 37 months before and 33 months after CPG implementation (post-CPG) using a single electronic health record system.
    RESULTS: Albuterol delivery via MDI-spacer increased by 33.95% (P < 0.0001) during 1-month post-CPG implementation with no significant subsequent decrease. An unexpected decline was noted for median LOS before CPG implementation (-1.24 minutes; P < 0.0001). For MDI-spacer-treated patients post-CPG, decreased median LOS was maintained and there was decreased variability of the median LOS (P < 0.001). For nebulizer-treated patients post-CPG, median LOS increased (.95 minutes; P = 0.033). No change was observed for 72-hour return rates.
    CONCLUSIONS: Implementation of an asthma CPG increased ordering of albuterol via MDI-spacer. The increase was sustained over time in all study sites. Decreased variability in median LOS for MDI-spacer patients was observed post-CPG. Median LOS for those treated with MDI-spacer exclusively remained unchanged in the post-CPG period, whereas post-CPG LOS increased in those who received nebulized albuterol.

    PMID: 28169982 [PubMed - as supplied by publisher]

  61. Bone Health and Bone-targeted Therapies for Prostate Cancer: a Programme in Evidence-based Care - Cancer Care Ontario Clinical Practice Guideline.

    mehr Informationen auf PubMed

    Related Articles

    Clin Oncol (R Coll Radiol). 2017 Feb 03;:

    Authors: Alibhai SM, Zukotynski K, Walker-Dilks C, Emmenegger U, Finelli A, Morgan SC, Hotte SJ, Winquist E, Cancer Care Ontario Genitourinary Cancer Disease Site Group

    Abstract
    AIMS: To make recommendations with respect to bone health and bone-targeted therapies in men with prostate cancer.
    MATERIALS AND METHODS: A systematic review was carried out by searching MEDLINE, EMBASE and the Cochrane Library from inception to January 2016. Systematic reviews and randomised-controlled trials were considered for inclusion if they involved therapies directed at improving bone health or outcomes such as skeletal-related events, pain and quality of life in patients with prostate cancer either with or without metastases to bone. Therapies included medications, supplements or lifestyle modifications alone or in combination and were compared with placebo, no treatment or other agents. Disease-targeted agents such as androgen receptor-targeted and chemotherapeutic agents were excluded. Recommendations were reviewed by internal and external review groups.
    RESULTS: In men with prostate cancer receiving androgen deprivation therapy, baseline bone mineral density testing is encouraged. Denosumab should be considered for reducing the risk of fracture in men on androgen deprivation therapy with an increased fracture risk. Bisphosphonates were effective in improving bone mineral density, but the effect on fracture was inconclusive. No medication is recommended to prevent the development of first bone metastasis. Denosumab and zoledronic acid are recommended for preventing or delaying skeletal-related events in men with metastatic castration-resistant prostate cancer. Radium-223 is recommended for reducing symptomatic skeletal events and prolonging survival in men with symptomatic metastatic castration-resistant prostate cancer.
    CONCLUSIONS: The recommendations represent a current standard of care that is feasible to implement, with outcomes valued by clinicians and patients.

    PMID: 28169118 [PubMed - as supplied by publisher]

  62. Evidence Based Medicine vs. Expert Consensus in Medical Guidelines: An Artificial Conflict.

    mehr Informationen auf PubMed

    Related Articles

    Neuromodulation. 2017 Feb;20(2):93-95

    Authors: Levy RM

    PMID: 28168826 [PubMed - indexed for MEDLINE]

  63. Improving adherence to colorectal cancer surveillance guidelines: results of a randomised controlled trial.

    mehr Informationen auf PubMed

    Related Articles

    BMC Cancer. 2017 Feb 06;17(1):106

    Authors: Carey M, Sanson-Fisher R, Macrae F, Cameron E, Hill D, D'Este C, Doran C

    Abstract
    BACKGROUND: Colorectal cancer (CRC) survivors are at increased risk of developing the disease again. Surveillance guidelines are aimed at maximising the early detection of recurring or new cancers and pre-cancerous polyps. The frequency and type of surveillance recommended depends on the type of treatment for the initial CRC, the extent of colonoscopic investigation prior to treatment and the results of previous surveillance tests. This paper aimed to test the effect of a paper-based educational intervention to improve adherence to colonoscopy following treatment for colorectal cancer.
    METHODS: People with a diagnosis of colorectal cancer within the last 10 months, aged ≥18 and English speaking were recruited through a population-based cancer registry in Australia. Participants were randomly allocated to either the intervention or control. Participants completed an interview at baseline. Self-reported participation in colonoscopy was obtained at 12 month followup by survey. Those allocated to the control received a generic pamphlet on colorectal cancer treatment; while intervention participants received a letter which provided specific information about guideline recommendations for surveillance colonoscopy. Rates of guideline adherence were compared between groups. The guideline recommendations for the timing of surveillance colonoscopy changed part way through the study. This change occurred after all intervention materials had been sent, but prior to all participants completing the 12 month follow up. Post hoc analyses were conducted to assess adherence to the new guidelines.
    RESULTS: Of the 767 participants, 604 (79%) had had surgery, had stage I - III disease and completed the baseline interview within 12 months of diagnosis (intervention = 305; control = 299). There was no significant difference between those adherent to surveillance colonoscopy guidelines, in the control (67, 27%) and intervention groups (80, 31%) at followup (difference = 4.3% (95%CI:-3.7%, 12%), χ (2)(1df) = 1.09, P = 0.296). Overall, 246 (49%) participants were adherent to the new guidelines, compared to 147 (29%) adherent to the old guidelines.
    CONCLUSIONS: Results indicate the paper-based educational intervention is not effective in improving adherence to colorectal cancer surveillance guidelines for colonoscopy.
    TRIAL REGISTRATION NUMBER: ACTRN12609000628246 Registration date: 28/07/2009.

    PMID: 28166751 [PubMed - in process]

  64. Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guideline From the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and the American Society of Clinical Oncology.

    mehr Informationen auf PubMed

    J Clin Oncol. 2017 Feb 06;:JCO2016719807

    Authors: Sepulveda AR, Hamilton SR, Allegra CJ, Grody W, Cushman-Vokoun AM, Funkhouser WK, Kopetz SE, Lieu C, Lindor NM, Minsky BD, Monzon FA, Sargent DJ, Singh VM, Willis J, Clark J, Colasacco C, Rumble RB, Temple-Smolkin R, Ventura CB, Nowak JA

    Abstract
    Purpose Molecular testing of colorectal cancers (CRCs) to improve patient care and outcomes of targeted and conventional therapies has been the center of many recent studies, including clinical trials. Evidence-based recommendations for the molecular testing of CRC tissues to guide epidermal growth factor receptor (EGFR) -targeted therapies and conventional chemotherapy regimens are warranted in clinical practice. The purpose of this guideline is to develop evidence-based recommendations to help establish standard molecular biomarker testing for CRC through a systematic review of the literature. Methods The American Society for Clinical Pathology (ASCP), College of American Pathologists (CAP), Association for Molecular Pathology (AMP), and the American Society of Clinical Oncology (ASCO) convened an Expert Panel to develop an evidence-based guideline to help establish standard molecular biomarker testing, guide targeted therapies, and advance personalized care for patients with CRC. A comprehensive literature search that included over 4,000 articles was conducted to gather data to inform this guideline. Results Twenty-one guideline statements (eight recommendations, 10 expert consensus opinions and three no recommendations) were established. Recommendations Evidence supports mutational testing for genes in the EGFR signaling pathway, since they provide clinically actionable information as negative predictors of benefit to anti-EGFR monoclonal antibody therapies for targeted therapy of CRC. Mutations in several of the biomarkers have clear prognostic value. Laboratory approaches to operationalize molecular testing for predictive and prognostic molecular biomarkers involve selection of assays, type of specimens to be tested, timing of ordering of tests and turnaround time for testing results. Additional information is available at: www.asco.org/CRC-markers-guideline and www.asco.org/guidelineswiki.

    PMID: 28165299 [PubMed - as supplied by publisher]

  65. Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guideline From the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology.

    mehr Informationen auf PubMed

    Related Articles

    Arch Pathol Lab Med. 2017 Feb 06;:

    Authors: Sepulveda AR, Hamilton SR, Allegra CJ, Grody W, Cushman-Vokoun AM, Funkhouser WK, Kopetz SE, Lieu C, Lindor NM, Minsky BD, Monzon FA, Sargent DJ, Singh VM, Willis J, Clark J, Colasacco C, Bryan Rumble R, Temple-Smolkin R, B Ventura C, Nowak JA

    Abstract
    OBJECTIVES: -To develop evidence-based guideline recommendations through a systematic review of the literature to establish standard molecular biomarker testing of colorectal cancer (CRC) tissues to guide epidermal growth factor receptor (EGFR) therapies and conventional chemotherapy regimens.
    METHODS: -The American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology convened an expert panel to develop an evidence-based guideline to establish standard molecular biomarker testing and guide therapies for patients with CRC. A comprehensive literature search that included more than 4,000 articles was conducted.
    RESULTS: -Twenty-one guideline statements were established.
    CONCLUSIONS: -Evidence supports mutational testing for EGFR signaling pathway genes, since they provide clinically actionable information as negative predictors of benefit to anti-EGFR monoclonal antibody therapies for targeted therapy of CRC. Mutations in several of the biomarkers have clear prognostic value. Laboratory approaches to operationalize CRC molecular testing are presented.

    PMID: 28165284 [PubMed - as supplied by publisher]

  66. [Evidence-based clinical practice guidelines for the treatment of dural tears and the consequent cerebrospinal fluid leak during spine surgery].

    mehr Informationen auf PubMed

    Related Articles

    Zhonghua Wai Ke Za Zhi. 2017 Feb 01;55(2):86-89

    Authors: Chinese Association of Orthopaedic Surgeons, Editorial Board of Evidence-Based Clinical Practice Guidelines for the Treatment of Dural Tears and the Consequent Cerebrospinal Fluid Leak During Spine Surgery, Beijing 100027, China

    Abstract
    Dural tears (DT) and the consequent cerebral spinal fluid (CSF) leak are not rare in spine surgeries. CSF leak can be troublesome, leading to pseudomeningocele, cutaneous CSF fistula, and meningitis. Revision surgery is unavoidable in some cases. The reported incidences of DT and CSF leak are different according to the various pathologies. Ossification of the posterior longitudinal ligament, revision spine surgery and multi-segment laminectomy have higher risks for DT. Various techniques have been described to manage this complication, such as bed rest, repair with dural substitutes, fibrin glue, gelatin sponge, lumbar drain, muscle flap, etc.Through objective evaluation of the evidence and transparency in the process of making recommendations, it is Chinese Association of Orthopaedic Surgeons' goal to develop evidence-based clinical practice guidelines for the treatment of incidental DT and the consequent CSF leak during spine surgery. The current clinical guidelines focus on 9 clinical questions and the strength of recommendations were made based on the quality of the literature. The work group considers that this guideline recommendations aim to assist in delivering optimum, efficacious treatment and functional recovery from this complication.

    PMID: 28162204 [PubMed - in process]

  67. [Guidelines from the DOG, RG and BVA: retinal artery occlusion : November 2016 status].

    mehr Informationen auf PubMed

    Related Articles

    Ophthalmologe. 2017 Feb;114(2):120-131

    Authors: Deutsche Ophthalmologische Gesellschaft, Retinologische Gesellschaft e. V., Berufsverband der Augenärzte Deutschlands e. V.

    PMID: 28160122 [PubMed - in process]

  68. [Evaluation of tumor-infiltrating lymphocytes in breast cancer: How to use the 2014 international guidelines?]

    mehr Informationen auf PubMed

    Related Articles

    Ann Pathol. 2017 Feb;37(1):127-132

    Authors: Joyon N, Kordahi M, Blanc-Fournier C, Lacroix-Triki M

    Abstract
    With the major development of immunotherapies, evaluation of the immune response associated to cancer has become the new challenge for pathologists. In breast cancer, this perspective has been notably anticipated by the recent publication, in 2014, of international guidelines for assessment of tumor-infiltrating lymphocytes (TILs), on routine haematoxylin-eosin stains. This technical article aims at reviewing the main key points and different steps in evaluation of tumor-infiltrating lymphocytes, in order to allow an easy implementation of this putative biomarker in routine practice. Widespread diffusion of international guidelines is the key to development of a standardized and reproducible biomarker. This early learning phase is of particular importance, as immune response will probably play a major role as a prognostic and predictive biomarker, especially in triple-negative and HER2 positive breast cancer.

    PMID: 28159402 [PubMed - in process]

  69. Guideline Implementation: Hand Hygiene.

    mehr Informationen auf PubMed

    Related Articles

    AORN J. 2017 Feb;105(2):203-212

    Authors: Goldberg JL

    Abstract
    Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

    PMID: 28159079 [PubMed - in process]

  70. Evidence to Support Oxygen Guidelines for Children with Emergency Signs in Developing Countries: A Systematic Review and Physiological and Mechanistic Analysis.

    mehr Informationen auf PubMed

    J Trop Pediatr. 2017 Feb 01;:

    Authors: Tosif S, Duke T

    PMID: 28158795 [PubMed - as supplied by publisher]

  71. Survival impact of centralization and clinical guidelines for soft tissue sarcoma (A prospective and exhaustive population-based cohort).

    mehr Informationen auf PubMed

    Related Articles

    PLoS One. 2017;12(2):e0158406

    Authors: Derbel O, Heudel PE, Cropet C, Meeus P, Vaz G, Biron P, Cassier P, Decouvelaere AV, Ranchere-Vince D, Collard O, De Laroche E, Thiesse P, Farsi F, Cellier D, Gilly FN, Blay JY, Ray-Coquard I

    Abstract
    PURPOSE: The outcome of sarcoma has been suggested in retrospective and non-exhaustive studies to be better through management by a multidisciplinary team of experts and adherence to clinical practice guidelines (CPGs). The aim of this prospective and exhaustive population based study was to confirm the impact of adherence to CPGs on survival in patients with localized sarcoma.
    EXPERIMENTAL DESIGN: Between 2005 and 2007, all evaluable adult patients with a newly diagnosis of localized sarcoma located in Rhone Alpes region (n = 634), including 472 cases of soft-tissue sarcoma (STS), were enrolled. The prognostic impact of adherence to CPGs on progression-free survival (PFS) and overall survival (OS) was assessed by multivariate Cox model in this cohort.
    RESULTS: The median age was 61 years (range 16-92). The most common subtypes were liposarcoma (n = 133, 28%), unclassified sarcoma (n = 98, 20.7%) and leiomyosarcoma (n = 69, 14.6%). In the initial management phase, from diagnosis to adjuvant treatment, the adherence to CPGs for patients with localized STS was 36% overall, corresponding to 56%, 85%, 96% and 84% for initial surgery, radiation therapy, chemotherapy and follow-up, respectively. Adherence to CPGs for surgery was the strongest independent prognostic factor of PFS, along with age, gender, grade, and tumor size. For OS, multivariate analysis adherence to CPGs for surgery was a strong independent prognostic factor, with an important interaction with a management in the regional expert centers.
    CONCLUSIONS: This study demonstrates impact of CPGs and treatment within an expert center on survival for STS patients in a whole population-based cohort.

    PMID: 28158190 [PubMed - in process]

  72. [Evidence-based guidelines : Cookbook medicine or key to better care?]

    mehr Informationen auf PubMed

    Related Articles

    Z Rheumatol. 2017 Feb 02;:

    Authors: Zink A, Hellmich B

    PMID: 28154934 [PubMed - as supplied by publisher]

  73. [Diagnostics of malignant melanoma of the skin : Recommendations of the current S3 guidelines on histology and molecular pathology].

    mehr Informationen auf PubMed

    Related Articles

    Pathologe. 2017 Feb;38(1):49-61

    Authors: Rose C

    Abstract
    The updated S3 guidelines on malignant melanoma were established in August 2016. The principles of diagnostics and classification are based on the histopathological results from the primary tumor and if necessary the sentinel lymph nodes. The most important factor for prognosis is the tumor thickness according to Breslow and the detection of sentinel node micrometastases. The surgical safety margin after excision is dependent on the tumor thickness. Furthermore, ulceration of the primary tumor and presence of mitosis in melanomas less than 1 mm in thickness are also considered in the T‑classification. The sentinel lymph nodes should be prepared according to established procedures using HE staining and immunohistochemical methods. The largest tumor diameter of a micrometastasis should be measured in tenths of a millimeter (Rotterdam classification). Molecular pathology testing for mutations in the BRAF and NRAS oncogenes should be carried out in patients with metastatic disease or surgically non-resectable tumors. In addition c-KIT mutations should be tested in acral lentiginous and mucosal melanomas. Treatment with signal transduction inhibitors is possible when mutations have been detected.

    PMID: 28154916 [PubMed - in process]

  74. Long-Term Oxygen Therapy: Comparison of the German and British Guidelines.

    mehr Informationen auf PubMed

    Respiration. 2017 Feb 01;:

    Authors: Magnet FS, Schwarz SB, Callegari J, Criée CP, Storre JH, Windisch W

    Abstract
    BACKGROUND: The German guideline on long-term oxygen therapy (LTOT) was published in 2008 by the German Respiratory Society (DGP), while the British Thoracic Society (BTS) published their most recent guideline in 2015.
    OBJECTIVES: The aim of the present article was to highlight the major areas of consensus and disagreement in the recently published BTS and DGP guidelines on LTOT.
    METHODS: The BTS and DGP guidelines were directly compared in terms of congruencies and differences. A critical appraisal was then performed and authors' suggestions were provided.
    RESULTS: The 2 guidelines are almost congruent in 2 major areas, namely, (1) the indication criteria for LTOT in chronic obstructive pulmonary disease (COPD) patients at rest and (2) the recommended duration of LTOT over a 24-h period. However, 8 major areas in which the guidelines differ considerably were identified: (1) techniques for blood gas analysis; (2) timing of LTOT in stable patients; (3) LTOT in post-exacerbation COPD patients; (4) ambulatory oxygen therapy; (5) nocturnal oxygen therapy; (6) titration of oxygen flow rates; (7) follow-up visits; and (8) LTOT for patients who still smoke. Furthermore, the BTS guideline is much more detailed, includes more references (161 vs. 71) and is more up to date than the DGP guideline.
    CONCLUSION: There are major differences between the 2 guidelines. Many of the aspects raised by the BTS guideline appear to be reasonable with regard to the current literature, clinical experience and prescription practices. However, an international consensus on LTOT is lacking.

    PMID: 28142139 [PubMed - as supplied by publisher]

  75. Evaluation of the methodological quality of two contradictory guidelines recently published by the Haute autorité de santé.

    mehr Informationen auf PubMed

    Related Articles

    Ann Biol Clin (Paris). 2017 Feb 01;75(1):101-106

    Authors: Watine J, Wils J, Augereau C

    Abstract
    Two clinical practice guidelines published in 2012 and in 2013 by the Haute autorité de santé (HAS) respectively entitled "Adult chronic kidney disease" (clinical pathway guidelines) and "Clinical utility of vitamin D measurements" (Health technology assessment) contradict each other on a notable point: in 2012 the HAS recommend to measure blood concentrations of vitamin D once a year in all patients with chronic kidney disease whereas in 2013 the HAS recommend to use this test only for the ambulatory follow-up of patients three months after kidney transplantation. This contradiction encouraged us to evaluate the methodological quality of these two guidelines with the help of the AGREE (Appraisal of Guidelines for Research and Evaluation) instrument which is consensual at an international level, in particular at the WHO (World Health Organization) and at the European Union. At the end of this comparative evaluation this preliminary hypothesis might be proposed: a more rigorous development (AGREE domain n̊3) as well as a higher editorial independence (AGREE domain n̊6) in 2013 than in 2012 (scores respectively are 57% and 56% in 2013 versus 24% and 25% in 2012) ensure a higher validity to the 2013 recommendations than to the 2012 recommendations. However this hypothesis is weakened by the subjective intrinsic value of the AGREE tool, and by various methodological shortcomings in these two guidelines. Therefore we conclude, using the AGREE terminology, that the methods for developing those guidelines are too uncertain, above all in 2012, for recommending their use without modifications.

    PMID: 28132938 [PubMed - indexed for MEDLINE]

  76. ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

    mehr Informationen auf PubMed

    Related Articles

    J Am Coll Cardiol. 2017 Feb 28;69(8):1076-1092

    Authors: Chan WV, Pearson TA, Bennett GC, Cushman WC, Gaziano TA, Gorman PN, Handler J, Krumholz HM, Kushner RF, MacKenzie TD, Sacco RL, Smith SC, Stevens VJ, Wells BL

    Abstract
    BACKGROUND: In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity.
    OBJECTIVES: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines.
    METHODS: This systematic review was conducted on 4 critical questions, each focusing on the adoption and effectiveness of 4 intervention strategies: (1) reminders, (2) educational outreach visits, (3) audit and feedback, and (4) provider incentives. A scoping review of the Rx for Change database of systematic reviews was used to identify promising guideline implementation interventions aimed at providers. Inclusion and exclusion criteria were developed a priori for each question, and the published literature was initially searched up to 2012, and then updated with a supplemental search to 2015. Two independent reviewers screened the returned citations to identify relevant reviews and rated the quality of each included review.
    RESULTS: Audit and feedback and educational outreach visits were generally effective in improving both process of care (15 of 21 reviews and 12 of 13 reviews, respectively) and clinical outcomes (7 of 12 reviews and 3 of 5 reviews, respectively). Provider incentives showed mixed effectiveness for improving both process of care (3 of 4 reviews) and clinical outcomes (3 reviews equally distributed between generally effective, mixed, and generally ineffective). Reminders showed mixed effectiveness for improving process of care outcomes (27 reviews with 11 mixed and 3 generally ineffective results) and were generally ineffective for clinical outcomes (18 reviews with 6 mixed and 9 generally ineffective results). Educational outreach visits (2 of 2 reviews), reminders (3 of 4 reviews), and provider incentives (1 of 1 review) were generally effective for cost reduction. Educational outreach visits (1 of 1 review) and provider incentives (1 of 1 review) were also generally effective for cost-effectiveness outcomes. Barriers to clinician adoption or adherence to guidelines included time constraints (8 reviews/overviews); limited staffing resources (2 overviews); timing (5 reviews/overviews); clinician skepticism (5 reviews/overviews); clinician knowledge of guidelines (4 reviews/overviews); and higher age of the clinician (1 overview). Facilitating factors included guideline characteristics such as format, resources, and end-user involvement (6 reviews/overviews); involving stakeholders (5 reviews/overviews); leadership support (5 reviews/overviews); scope of implementation (5 reviews/overviews); organizational culture such as multidisciplinary teams and low-baseline adherence (9 reviews/overviews); and electronic guidelines systems (3 reviews).
    CONCLUSION: The strategies of audit and feedback and educational outreach visits were generally effective in improving both process of care and clinical outcomes. Reminders and provider incentives showed mixed effectiveness, or were generally ineffective. No general conclusion could be reached about cost effectiveness, because of limitations in the evidence. Important gaps exist in the evidence on effectiveness of implementation interventions, especially regarding clinical outcomes, cost effectiveness and contextual issues affecting successful implementation.

    PMID: 28132746 [PubMed - in process]

  77. Addressing Knowledge Gaps in the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: a Review of Recent Coronary Artery Calcium Literature.

    mehr Informationen auf PubMed

    Related Articles

    Curr Atheroscler Rep. 2017 Feb;19(2):7

    Authors: Sathiyakumar V, Blumenthal RS, Nasir K, Martin SS

    Abstract
    PURPOSE OF REVIEW: Coronary artery calcium (CAC) has been proposed as an integrator of information from traditionally measured, non-traditionally measured, and unmeasured risk factors for coronary atherosclerosis. The 2013 American College of Cardiology/American Heart Association Guideline on the Assessment of Cardiovascular Risk identified several knowledge gaps regarding CAC, including radiation risks, cost-effectiveness, and improving discrimination and reclassification of estimated risk over the Pooled Cohort Equations in the ACC/AHA Atherosclerotic Cardiovascular Disease Estimator. In this review, we focus on recent CAC literature addressing these knowledge gaps. We further highlight the potential for CAC to enrich future randomized controlled trials.
    RECENT FINDINGS: The use of CAC allows for personalization of cardiovascular risk despite the presence or absence of traditional risk factors across many demographics. Avenues to reduce radiation exposure associated with CAC scanning include increasing the interval between scans for those with CAC scores of zero and estimating CAC from non-cardiac gated CT scans. While limited studies have suggested cost-effectiveness in cardiac risk assessment with the incorporation of CAC in screening algorithms, several studies have demonstrated the ability of CAC to identify non-traditional risk factors that may be used to expand cardiovascular risk personalization in other high-risk populations. Literature from the past 2 years further supports CAC as a strong marker to personalize cardiac risk assessment. While multiple potential avenues to reduce radiation are available and cost-effectiveness analyses are encouraging, further studies are necessary to clarify patient selection for CAC scanning given the interplay between CAC and other imaging modalities in risk personalization algorithms.

    PMID: 28130653 [PubMed - in process]

  78. Evidence-Based Practice Guideline : Acute Pain Management in Older Adults.

    mehr Informationen auf PubMed

    Related Articles

    J Gerontol Nurs. 2017 Feb 01;43(2):18-27

    Authors: Cornelius R, Herr KA, Gordon DB, Kretzer K, Butcher HK

    Abstract
    Acute pain is a prevalent problem in a growing segment of the older adult population and is often ineffectively managed despite the accumulation of evidence to guide assessment and support interventions in managing pain. Improvements in acute pain management in older adults are needed to provide consistent and quality pain assessment techniques and treatment therapies consistent with patient and/or family preferences. The current article briefly discusses ways to improve the pain experience and outcomes for older patients and families. [Journal of Gerontological Nursing, 43(2), 18-27.].

    PMID: 28128395 [PubMed - in process]

  79. ACC/AHA Special Report: Clinical Practice Guideline Implementation Strategies: A Summary of Systematic Reviews by the NHLBI Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

    mehr Informationen auf PubMed

    Related Articles

    Circulation. 2017 Feb 28;135(9):e122-e137

    Authors: Chan WV, Pearson TA, Bennett GC, Cushman WC, Gaziano TA, Gorman PN, Handler J, Krumholz HM, Kushner RF, MacKenzie TD, Sacco RL, Smith SC, Stevens VJ, Wells BL, Castillo G, Heil SK, Stephens J, Vann JC

    Abstract
    BACKGROUND: In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity.
    OBJECTIVES: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines.
    METHODS: This systematic review was conducted on 4 critical questions, each focusing on the adoption and effectiveness of 4 intervention strategies: (1) reminders, (2) educational outreach visits, (3) audit and feedback, and (4) provider incentives. A scoping review of the Rx for Change database of systematic reviews was used to identify promising guideline implementation interventions aimed at providers. Inclusion and exclusion criteria were developed a priori for each question, and the published literature was initially searched up to 2012, and then updated with a supplemental search to 2015. Two independent reviewers screened the returned citations to identify relevant reviews and rated the quality of each included review.
    RESULTS: Audit and feedback and educational outreach visits were generally effective in improving both process of care (15 of 21 reviews and 12 of 13 reviews, respectively) and clinical outcomes (7 of 12 reviews and 3 of 5 reviews, respectively). Provider incentives showed mixed effectiveness for improving both process of care (3 of 4 reviews) and clinical outcomes (3 reviews equally distributed between generally effective, mixed, and generally ineffective). Reminders showed mixed effectiveness for improving process of care outcomes (27 reviews with 11 mixed and 3 generally ineffective results) and were generally ineffective for clinical outcomes (18 reviews with 6 mixed and 9 generally ineffective results). Educational outreach visits (2 of 2 reviews), reminders (3 of 4 reviews), and provider incentives (1 of 1 review) were generally effective for cost reduction. Educational outreach visits (1 of 1 review) and provider incentives (1 of 1 review) were also generally effective for cost-effectiveness outcomes. Barriers to clinician adoption or adherence to guidelines included time constraints (8 reviews/overviews); limited staffing resources (2 overviews); timing (5 reviews/overviews); clinician skepticism (5 reviews/overviews); clinician knowledge of guidelines (4 reviews/overviews); and higher age of the clinician (1 overview). Facilitating factors included guideline characteristics such as format, resources, and end-user involvement (6 reviews/overviews); involving stakeholders (5 reviews/overviews); leadership support (5 reviews/overviews); scope of implementation (5 reviews/overviews); organizational culture such as multidisciplinary teams and low-baseline adherence (9 reviews/overviews); and electronic guidelines systems (3 reviews).
    CONCLUSION: The strategies of audit and feedback and educational outreach visits were generally effective in improving both process of care and clinical outcomes. Reminders and provider incentives showed mixed effectiveness, or were generally ineffective. No general conclusion could be reached about cost effectiveness, because of limitations in the evidence. Important gaps exist in the evidence on effectiveness of implementation interventions, especially regarding clinical outcomes, cost effectiveness and contextual issues affecting successful implementation.

    PMID: 28126839 [PubMed - in process]

  80. [Treatment with psychotropic agents in patients with dementia and delirium : Gap between guideline recommendations and treatment practice].

    mehr Informationen auf PubMed

    Related Articles

    Z Gerontol Geriatr. 2017 Feb;50(2):106-114

    Authors: Hewer W, Thomas C

    Abstract
    BACKGROUND AND OBJECTIVES: Psychiatric symptoms in dementia and delirium are associated with a substantially reduced quality of life of patients and their families and often challenging for professionals. Pharmacoepidemiological surveys have shown that, in particular, patients living in nursing homes receive prescriptions of psychotropic agents in significant higher frequency than recommended by current guidelines. This article focuses on a critical appraisal of this gap from the point of view of German healthcare services.
    MATERIAL AND METHODS: Narrative review with special reference to the German dementia guideline from 2016 and recently published practice guidelines for delirium in old age in German and English language.
    RESULTS: The indications for use of psychotropic agents, especially antipsychotics, are defined narrowly in the German dementia guideline. According to this guideline for several psychopathological symptoms evidence based recommendations cannot be given, currently. For delirium several practice guidelines related to different treatment settings have been published recently. Comparable to the German dementia guideline they recommend general medical interventions and nonpharmacological treatment as first line measures and the use of psychotropic agents only under certain conditions. These guidelines differ to some extent regarding the strength of recommendation for psychopharmacological treatment.
    CONCLUSION: The guidelines discussed here advocate well-founded a cautious prescription of psychotropic agents in patients with dementia and delirium. This contrasts to everyday practice which is characterized by significantly higher prescription rates. This gap may explained partially by a lack of evidence-based recommendations regarding certain psychopathological symptoms. Most notably, however, epidemiological data disclose an unacceptable rate of hazardous overtreatment with psychotropic agents, especially in long-term care of persons with dementia. In this situation counteractive measures by consequent implementation of the principles of good clinical practice in geriatrics are required urgently.

    PMID: 28124100 [PubMed - in process]

  81. Quality assessment of clinical practice guidelines for eosinophilic esophagitis using the AGREE II instrument.

    mehr Informationen auf PubMed

    Expert Rev Gastroenterol Hepatol. 2017 Feb 01;:1-8

    Authors: Lucendo AJ, Arias Á, Redondo-González O, Molina-Infante J

    Abstract
    BACKGROUND: High-quality evidence-based clinical practice guidelines can guide diagnosis and treatment to optimize outcomes. We aimed to systematically review the quality of international guidelines on eosinophilic esophagitis (EoE).
    METHODS: MEDLINE and Scopus databases were searched for appropriate guidelines up to 2016. Two gastroenterologists and two methodologists independently evaluated the documents using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.
    RESULTS: Amongst the 25 records initially retrieved, four guidelines developed by recognized scientific organizations met inclusion criteria. AGREE II results varied widely across domains, but none achieved an overall assessment score of over 60%. Scope and purpose (61.82 ± 19.24%), clarity of presentation (57.13 ± 40.56%) and editorial independence (93.75 ± 1.69%) showed the highest mean rating, whereas stakeholder involvement (28.82 ± 11.19%), rigor of development (32.29 ± 12.02%) and applicability (21.62 ± 7.14%) did not reach quality thresholds. Intraclass correlation coefficients for agreement was excellent among appraisers (0.903), between gastroenterologists and methodologists (0.878) and for each individual guideline (0.838 to 0.955).
    CONCLUSION: Clinical practice guidelines for EoE vary significantly in quality, are invariably limited and currently, none can be 'strongly recommended'.

    PMID: 28117605 [PubMed - as supplied by publisher]

  82. Lack of adherence to SHEA-IDSA treatment guidelines for Clostridium difficile infection is associated with increased mortality.

    mehr Informationen auf PubMed

    Related Articles

    J Antimicrob Chemother. 2017 Feb;72(2):574-581

    Authors: Patel I, Wungjiranirun M, Theethira T, Villafuerte-Galvez J, Castillo N, Akbari M, Alonso CD, Leffler DA, Kelly CP

    Abstract
    OBJECTIVES: The objective of this study was to determine our institution's compliance with 2010 Society for Healthcare Epidemiology of America and IDSA Clostridium difficile infection (CDI) treatment guidelines and their respective outcomes.
    METHODS: We collected clinical parameters, laboratory values, antibiotic therapy and clinical outcomes from the electronic medical records for all patients hospitalized at our institution with a diagnosis of CDI from December 2012 to November 2013. We specifically evaluated whether SHEA-IDSA treatment guidelines were followed and evaluated the associations between guideline adherence and severe outcomes including mortality.
    RESULTS: We identified 230 patients with CDI meeting inclusion criteria during the study period. Of these, 124 (54%) were appropriately treated, 46 (20%) were under-treated and 60 (26%) were over-treated. All-cause 90 day mortality was 17.4% overall; 43.5% in the under-treated group versus 12.9% in those appropriately treated (P < 0.0001) and 10.9% in those appropriately treated plus over-treated (P < 0.0001). Similarly, 90 day mortality attributed to CDI was 21.7% in those under-treated versus 8.9% in those appropriately treated (P = 0.03) and 8.2% in those either appropriately treated or over-treated (P = 0.015). Severe-complicated CDI occurred in 46 patients. In this subgroup, there was a non-significant trend towards increased mortality in under-treated patients (56.7%) compared with appropriately treated patients (37.5%, P = 0.35). Under-treatment was also associated with a higher rate of CDI-related ICU transfer (17.4% versus 4.8% in those appropriately treated, P = 0.023).
    CONCLUSIONS: Adherence to CDI treatment guidelines is associated with improved outcomes especially in those with severe disease. Increased emphasis on provision of appropriate, guideline-based CDI treatment appears warranted.

    PMID: 28115504 [PubMed - in process]

  83. Methodological quality, completeness of reporting and use of systematic reviews as evidence in clinical practice guidelines for paediatric overweight and obesity.

    mehr Informationen auf PubMed

    Related Articles

    Clin Obes. 2017 Feb;7(1):34-45

    Authors: Nissen T, Wayant C, Wahlstrom A, Sinnett P, Fugate C, Herrington J, Vassar M

    Abstract
    Paediatric obesity rates remain high despite extensive efforts to prevent and treat obesity in children. We investigated the quality of the methodology and reporting within systematic reviews (SRs) underpinning paediatric content in US clinical practice guidelines (CPGs). In June 2016 we searched guideline clearinghouses and professional organization websites for guidelines published by national or professional organizations in the United States from January 2007 onwards. In our primary, a priori analysis, we used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) instruments to score SRs and meta-analyses that included paediatric populations and were cited by included CPGs. In a secondary, post hoc analysis, we determined the extent to which US CPGs use available, relevant SRs and meta-analyses compared with non-US CPGs. Eight US-based CPGs with 27 references to 22 unique SRs were found. AMSTAR and PRISMA scores were low overall, with only three SRs having 'high' methodological quality. Items dealing with bias assessments and search strategies had especially low scores. US CPGs were also older on average and cited fewer SRs than their international counterparts. Low quality scores and dated guidelines should be a cause for concern among practicing clinicians and a call to action for future guideline developers, publishers and research institutions.

    PMID: 28112500 [PubMed - in process]

  84. Impact of Pancreatic Cyst Fluid CEA Levels on the Classification of Pancreatic Cysts Using the Papanicolaou Society of Cytology Terminology System for Pancreaticobiliary Cytology.

    mehr Informationen auf PubMed

    Related Articles

    Diagn Cytopathol. 2017 Feb;45(2):101-106

    Authors: Ajaj Saieg M, Munson V, Colletti S, Nassar A

    Abstract
    BACKGROUND: The new proposed classification for pancreaticobiliary cytology has advocated the use of carcinoembryonic antigen (CEA) analysis of cyst fluid as an ancillary diagnostic tool for the determination of mucinous neoplasms in pancreatic cyst aspirates. We aimed to investigate the effect of CEA cyst fluid analysis on cases primarily called negative or nondiagnostic and on the sensitivity and specificity of the method.
    METHODS: We retrospectively identified and collected all pancreatic cyst aspirates from 2010 to 2014 at Mayo Clinic, Jacksonville, Florida, along with available corresponding surgical diagnoses. Cases primarily classified as nondiagnostic or negative but that had a cyst CEA level of 192 ng mL(-1) or higher were reclassified as mucinous neoplasms. Cytohistologic correlation was assessed whenever possible.
    RESULTS: We retrieved pancreatic cyst aspirates from 255 patients who had a corresponding CEA level measurement. Median patient age was 70 years (range, 25-100 years). Among all samples, 129 (50.6%) had been classified as negative and 42 (16.4%) as nondiagnostic. Applying the new criteria, the number of samples previously classified as negative and nondiagnostic decreased considerably, with a statistically significant difference among negative cases. Fifty-four cases (21.2%) had an available corresponding surgical diagnosis, and complete agreement was achieved in 95.4% of the cases. Use of the new cutoff for CEA levels increased the sensitivity and negative predictive value, compared with the original diagnoses.
    CONCLUSIONS: The incorporation of the new proposed terminology and CEA fluid analysis has significantly decreased the number of samples primarily classified as negative and nondiagnostic, along with improved test characteristics. Diagn. Cytopathol. 2017;45:101-106. © 2016 Wiley Periodicals, Inc.

    PMID: 28110503 [PubMed - indexed for MEDLINE]

  85. Re: Evidence-Based Management Guidelines on Peyronie's Disease.

    mehr Informationen auf PubMed

    Related Articles

    J Urol. 2017 Feb;197(2):420-421

    Authors: Morey AF

    PMID: 28093157 [PubMed - in process]

  86. Are MIQE Guidelines Being Adhered to in qPCR Investigations in Photobiomodulation Experiments?

    mehr Informationen auf PubMed

    Photomed Laser Surg. 2017 Feb;35(2):69-70

    Authors: Houreld NN

    PMID: 28056213 [PubMed - in process]

  87. Summary of the proceedings of the international forum 2016: "Imaging referral guidelines and clinical decision support - how can radiologists implement imaging referral guidelines in clinical routine?"

    mehr Informationen auf PubMed

    Related Articles

    Insights Imaging. 2017 Feb;8(1):1-9

    Authors: European Society of Radiology (ESR)

    Abstract
    The International Forum is held once a year by the ESR and its international radiological partner societies with the aim to address and discuss selected subjects of global relevance in radiology. In 2016, the issue of implementing imaging referral guidelines in clinical routine was analysed. The legal environment in the USA requires that after January 1, 2017, physicians must consult government-approved, evidence-based appropriate-use criteria through a clinical decision support system when ordering advanced diagnostic imaging exams. The ESR and the National Decision Support Company are developing "ESR iGuide", a clinical decision support system for European imaging referral guidelines using ESR imaging referral guidelines based on ACR Appropriateness Criteria. In many regions of the world, the situation is different and quite diverse, depending on the specific features of health care systems in different countries, but there are, unlike in the USA and EU, no legal obligations to implement imaging referral guidelines into the clinical practice. Imaging referral guidelines and clinical decision support implementation is a complex issue everywhere and the legal environment surrounding it even more so; how they will be implemented into the clinical practice in different areas of the world needs yet to be decided.
    MAIN MESSAGES: • Implementation of imaging referral guidelines in clinical routine is needed. • Potential benefits are improved appropriateness in referrals and reduction of unnecessary radiation exposure. • The educational benefits include new insights through data collection and reporting. • The system will potentially highlight the lack in quality or availability of equipment.

    PMID: 28044260 [PubMed - in process]

  88. Factors influencing implementation success of guideline-based clinical decision support systems: A systematic review and gaps analysis.

    mehr Informationen auf PubMed

    Related Articles

    Int J Med Inform. 2017 Feb;98:56-64

    Authors: Kilsdonk E, Peute LW, Jaspers MW

    Abstract
    OBJECTIVE: To provide an integrated and differentiated understanding of factors influencing guideline-based CDSS implementation and illustrate the gaps in the current literature.
    MATERIALS AND METHODS: A systematic literature review and in-depth exploration of factors impeding or facilitating successful implementation of guideline-based CDSS supporting physicians in clinical decision-making was performed. Factors were identified thematically by textual analysis of the included publications and were individually mapped to the human, organization and technology-fit (HOT-fit) framework for evaluating implementations of health information systems.
    RESULTS: A total of 421 factors were found in 35 included publications from a total of 3676 publications. The mapping of factors concerning CDSS implementation on the HOT-fit framework revealed gaps in each domain of the framework and showed that research has mainly focused on human and technology factors and less on organizational factors.
    CONCLUSIONS: Future research within the field of guideline-based CDSS should focus on evaluating implementations through the use of socio-technical models to study guideline-based CDSS system implementations from a multidimensional view. Furthermore, research is needed to explore whether use of these models during the planning phases of a CDSS project is useful in anticipating and preventing implementation barriers from occurring and exploiting facilitators to a successful implementation of the system.

    PMID: 28034413 [PubMed - in process]

  89. Troponin Assessment in Heart Failure With Preserved Ejection Fraction: Time to Get With the Guidelines.

    mehr Informationen auf PubMed

    Related Articles

    JAMA Cardiol. 2017 Feb 01;2(2):125-126

    Authors: Sayer G, Uriel N

    PMID: 28030658 [PubMed - in process]

  90. Guidelines of the French Society of Otorhinolaryngology (SFORL) (short version). Specific treatment of epistaxis in Rendu-Osler-Weber disease.

    mehr Informationen auf PubMed

    Related Articles

    Eur Ann Otorhinolaryngol Head Neck Dis. 2017 Feb;134(1):37-41

    Authors: Robard L, Michel J, Prulière Escabasse V, Bequignon E, Vérillaud B, Malard O, Crampette L, SFORL Work-Group

    Abstract
    OBJECTIVES: The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) concerning specific treatment of epistaxis in Rendu-Osler-Weber disease.
    METHODS: A multidisciplinary work-group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.
    RESULTS: Rendu-Osler-Weber disease is diagnosed from the presence of at least three of Curaçao's four criteria. In acute epistaxis, bidigital compression is recommended. Embolization is reserved for resistant epistaxis. Non-resorbable nasal packing and cauterization are contraindicated. Patient education is essential. Telangiectasia of the nasal mucosa can be treated by various local means. In the event of insufficient control, systemic administration of tranexamic acid is recommended.

    PMID: 27986467 [PubMed - in process]

  91. How Well Do Laboratories Adhere to Recommended Clinical Guidelines for the Management of Myocardial Infarction? The Italian Experience.

    mehr Informationen auf PubMed

    Related Articles

    Clin Chem. 2017 Feb;63(2):610-612

    Authors: Cappelletti P, Morandini M, Moretti M, Malloggi L, Stenner E, Working Group on Myocardial Markers of Italian Society for Clinical Pathology and Laboratory Medicine (GdS MM SIPMeL)

    PMID: 27940447 [PubMed - in process]

  92. [Austrian guideline for palliative sedation therapy (long version) : Results of a Delphi process of the Austrian Palliative Society (OPG)].

    mehr Informationen auf PubMed

    Related Articles

    Wien Med Wochenschr. 2017 Feb;167(1-2):31-48

    Authors: Weixler D, Roider-Schur S, Likar R, Bozzaro C, Daniczek T, Feichtner A, Gabl C, Hammerl-Ferrari B, Kletecka-Pulker M, Körtner UH, Kössler H, Meran JG, Miksovsky A, Pusswald B, Wienerroither T, Watzke H

    Abstract
    BACKGROUND: Palliative sedation therapy (PST) is an important and ethically accepted therapy in the care of selected palliative care patients with otherwise unbearable suffering from refractory distress. PST is increasingly used in end-of-life care. Austria does not have a standardized ethical guideline for this exceptional practice near end of life, but there is evidence that practice varies throughout the country.
    OBJECTIVE: The Austrian Palliative Society (OPG) nominated a multidisciplinary working group of 16 palliative care experts and ethicists who established the national guideline on the basis of recent review work with the aim to adhere to the Europeans Association of Palliative Care's (EAPC) framework on palliative sedation therapy respecting Austrians legal, structural and cultural background.
    METHODS: Consensus was achieved by a four-step sequential Delphi process. The Delphi-process was strictly orientated to the recently published EUROIMPACT-sedation-study-checklist and to the AGREE-2-tool. Additionally national stakeholders participated in the reflection of the results.
    RESULTS: As a result of a rigorous consensus process the long version of the Austrian National Palliative Sedation Guideline contains 112 statements within eleven domains and is supplemented by a philosophers excursus on suffering.
    CONCLUSIONS: By establishing a national guideline for palliative sedation therapy using the Delphi technique for consensus and stakeholder involvement the Austrian Palliative Society aims to ensure nationwide good practice of palliative sedation therapy. Screening for the practicability and efficacy of this guideline will be a future task.

    PMID: 27924420 [PubMed - in process]

  93. Increased incidence of necrotizing enterocolitis in the Netherlands after implementation of the new Dutch guideline for active treatment in extremely preterm infants: Results from three academic referral centers.

    mehr Informationen auf PubMed

    Related Articles

    J Pediatr Surg. 2017 Feb;52(2):273-276

    Authors: Heida FH, Stolwijk L, Loos MH, van den Ende SJ, Onland W, van den Dungen FA, Kooi EM, Bos AF, Hulscher JB, Bakx R

    Abstract
    INTRODUCTION: Necrotizing enterocolitis (NEC) is a severe inflammatory disease, mostly occurring in preterm infants. The Dutch guidelines for active treatment of extremely preterm infants changed in 2006 from 26+0 to 25+0weeks of gestation, and in 2010 to 24+0 of gestation. We aimed to gain insight into the incidence, clinical outcomes and treatment strategies, in three academic referral centers in the Netherlands over the last nine years.
    METHODS: We performed a multicenter retrospective cohort study of all patients with NEC (Bell stage ≥2a) in three academic referral centers diagnosed between 2005 and 2013. Outcome measures consisted of incidence, changes in clinical presentation, treatment strategies and mortality.
    RESULTS: Between 2005 and 2013 14,161 children were admitted to the neonatal intensive care unit in the three centers. The overall percentage of children born at a gestational age of 24weeks and 25weeks increased with 1.7% after the introduction of the guidelines in 2006 and 2010. The incidence of NEC increased significantly (period 2005-2007: 2.1%; period 2008-2010 3.9%; period 2011-2013: 3.4%; P=0.001). We observed a significant decrease of peritoneal drainages (↓16%; P=0.001) and a decrease of laparotomies (↓24%; P=0.002). The mortality rate (33% in 2011-2013) remained unchanged.
    CONCLUSION: The incidence of NEC significantly increased in the last nine years. The increase in incidence of NEC seemed to be related to an increase in infants born at a gestational age of 24 and 25weeks. The percentage of patients needing surgery decreased, while 30-day mortality did not change.
    LEVEL OF EVIDENCE: Level IV.

    PMID: 27923478 [PubMed - indexed for MEDLINE]

  94. S2k-Guideline Helicobacter pylori and gastroduodenal ulcer disease.

    mehr Informationen auf PubMed

    Related Articles

    Z Gastroenterol. 2017 Feb;55(2):167-206

    Authors: Authors, Responsible in representation of the DGVS:

    PMID: 27919112 [PubMed - in process]

  95. "Evaluation of chronic obstructive pulmonary disease (COPD) and reduced ejection fraction heart failure (HFrEF) discharge medication prescribing: Is drug therapy concordant with national guidelines associated with a reduction in 30-day readmissions?" [Respir. Med. 119 (October 2016) 135-140].

    mehr Informationen auf PubMed

    Related Articles

    Respir Med. 2017 Feb;123:150

    Authors: Richardson A, Tolley E, Hartmann J, Reedus J, Bowlin B, Finch C, Sands CW, Self T

    PMID: 27916482 [PubMed - in process]

  96. Substantial reduction in hospital stay of children and adolescents with diabetic ketoacidosis after implementation of Clinical Practice Guidelines in a university hospital in Saudi Arabia.

    mehr Informationen auf PubMed

    Related Articles

    J Eval Clin Pract. 2017 Feb;23(1):173-177

    Authors: Al Nemri A, Amer YS, Gasim H, Osman ME, Aleyadhy A, Al Otaibi H, Iqbal SM, Aljurayyan NA, Assiri AM, Babiker A, Mohamed S

    Abstract
    RATIONALE, AIMS AND OBJECTIVES: We aimed to determine the effect of Clinical Practice Guideline (CPG) implementation on length of hospital stay of children and adolescents with diabetic ketoacidosis (DKA).
    METHODS: This was a 6-year (2008-2014) case-control retrospective study conducted at King Khalid University Hospital, Riyadh, that compared patients with DKA managed using CPG with those treated before CPG implementation.
    RESULTS: There were 63 episodes of DKA in 41 patients managed using CPG compared with 40 episodes in 33 patients treated before implementation of CPG. Baseline characteristics of the 2 groups were similar (age, sex, newly diagnosed patients, recurrent DKA, DKA severity, and mean glycosylated hemoglobin). The mean length of hospital stay (±SD) was 68.6 ± 53.1 hours after implementation of CPG compared with 107.4 ± 65.6 hours before implementation (P < .001). The reduction in length of hospital stay equals to 1700 bed days saved per year per 1000 patients.
    CONCLUSIONS: Implementation of CPG for DKA decreased the length of hospital stay.

    PMID: 27896902 [PubMed - in process]

  97. Comparison of cardiovascular risk assessment tools and their guidelines in evaluation of 10-year CVD risk and preventive recommendations: A population based study.

    mehr Informationen auf PubMed

    Related Articles

    Int J Cardiol. 2017 Feb 01;228:52-57

    Authors: Motamed N, Rabiee B, Perumal D, Poustchi H, Miresmail SJ, Farahani B, Maadi M, Saeedian FS, Ajdarkosh H, Khonsari MR, Hemasi GR, Zamani F

    Abstract
    BACKGROUND: Identification of individuals at risk of cardiovascular diseases (CVDs) results in better clinical outcomes and may help policy makers in conscious decision making for community based and national intervention strategies. The main aim of this study was to compare various CVD risk assessment tools and their related guidelines in estimation of 10-year CVD risk and subsequent therapeutic recommendations, respectively.
    METHODS: Data of 3086 subjects aged 40-74years from a cohort study of northern Iran were utilized in this cross-sectional study. The risks were calculated based on American College of Cardiology/American Heart Association (ACC/AHA) tool, two versions of Systematic Coronary Risk Evaluation (SCORE) equations (for low and high risk European countries) and Framingham approach. We also detected participants who ought to be recommended for treatment based on the specific guidelines related to each of the risk assessment tools.
    RESULTS: Mean cardiovascular risks were 12.96%, 8.84%, 1.90% and 3.45% in men and 5.87%, 2.13%, 0.8% and 1.13% in women based on ACC/AHA, Framingham, SCORE equation for low-risk European countries and high-risk European countries, respectively. Based on ACC/AHA, Adult Treatment Panel III (ATPIII) and European Society of Cardiology (ESC) guidelines related to SCORE equations for low and high risk European countries 58.2%, 27.1%, 21.1% and 28.6% of men and 39.7%, 33.0%, 29.5% and 30.7% of women were recommended to statin therapy, respectively.
    CONCLUSIONS: In conclusion, more individuals were recommended for treatment by ACC/AHA guideline than the other guidelines.

    PMID: 27863362 [PubMed - in process]

  98. Efficacy and Safety of the GuideLiner Mother-in-Child Guide Catheter Extension in Percutaneous Coronary Intervention.

    mehr Informationen auf PubMed

    Related Articles

    J Interv Cardiol. 2017 Feb;30(1):46-55

    Authors: Sharma D, Shah A, Osten M, Ing D, Barolet A, Overgaard CB, Džavík V, Seidelin PH

    Abstract
    BACKGROUND: Percutaneous coronary intervention (PCI) procedures are increasingly performed on complex tortuous and heavily calcified coronary lesions. The GuideLiner® catheter (Vascular Solutions, Inc. Minneapolis, MN) is a rapid exchange guide catheter extension system. There is paucity of data about the efficacy of this device in complex PCI. Therefore, we aim to report the indications, success, and efficacy of GuideLiner use in treating complex lesion subset in the present study.
    METHODS: We collected data from all patients in whom the GuideLiner was used to facilitate PCI between April 1, 2011 and December 31, 2014 at a tertiary referral center in Toronto, Canada. Demographic and procedural data were obtained from an institutional prospective data registry. Indications for use of the GuideLiner, and angiographic and procedural data specific to the device were also collected.
    RESULTS: The GuideLiner was utilized in 307 (317 lesions) of 6105 PCI procedures performed at our institution during the study period. The mean age was 68.4 ± 11.2 years and 82% were male. The majority of lesions were types B2 or C (98%), calcified (86.3%), with proximal tortuosity (88.6%). The overall technical success rate of the GuideLiner was 88%. The procedural success rate was 98.7%. The complication rate was low (1.6%).
    CONCLUSIONS: Use of the GuideLiner catheter facilitated successful completion of PCI procedures in a majority of patients with complex lesions. Operators should be aware of the potential complications associated with GuideLiner use.

    PMID: 27862338 [PubMed - in process]

  99. Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients.

    mehr Informationen auf PubMed

    Related Articles

    Crit Care Med. 2017 Feb;45(2):171-178

    Authors: Barnes-Daly MA, Phillips G, Ely EW

    Abstract
    OBJECTIVES: To track compliance by an interprofessional team with the Awakening and Breathing Coordination, Choice of drugs, Delirium monitoring and management, Early mobility, and Family engagement (ABCDEF) bundle in implementing the Pain, Agitation, and Delirium guidelines. The aim was to study the association between ABCDEF bundle compliance and outcomes including hospital survival and delirium-free and coma-free days in community hospitals.
    DESIGN: A prospective cohort quality improvement initiative involving ICU patients.
    SETTING: Seven community hospitals within California's Sutter Health System.
    PATIENTS: Ventilated and nonventilated general medical and surgical ICU patients enrolled between January 1, 2014, and December 31, 2014.
    MEASUREMENTS AND MAIN RESULTS: Total and partial bundle compliance were measured daily. Random effects regression was used to determine the association between ABCDEF bundle compliance accounting for total compliance (all or none) or for partial compliance ("dose" or number of bundle elements used) and outcomes of hospital survival and delirium-free and coma-free days, after adjusting for age, severity of illness, and presence of mechanical ventilation. Of 6,064 patients, a total of 586 (9.7%) died before hospital discharge. For every 10% increase in total bundle compliance, patients had a 7% higher odds of hospital survival (odds ratio, 1.07; 95% CI, 1.04-1.11; p < 0.001). Likewise, for every 10% increase in partial bundle compliance, patients had a 15% higher hospital survival (odds ratio, 1.15; 95% CI, 1.09-1.22; p < 0.001). These results were even more striking (12% and 23% higher odds of survival per 10% increase in bundle compliance, respectively, p < 0.001) in a sensitivity analysis removing ICU patients identified as receiving palliative care. Patients experienced more days alive and free of delirium and coma with both total bundle compliance (incident rate ratio, 1.02; 95% CI, 1.01-1.04; p = 0.004) and partial bundle compliance (incident rate ratio, 1.15; 95% CI, 1.09-1.22; p < 0.001).
    CONCLUSIONS: The evidence-based ABCDEF bundle was successfully implemented in seven community hospital ICUs using an interprofessional team model to operationalize the Pain, Agitation, and Delirium guidelines. Higher bundle compliance was independently associated with improved survival and more days free of delirium and coma after adjusting for age, severity of illness, and presence of mechanical ventilation.

    PMID: 27861180 [PubMed - in process]

  100. Barriers for guideline adherence in knee osteoarthritis care: A qualitative study from the patients' perspective.

    mehr Informationen auf PubMed

    Related Articles

    J Eval Clin Pract. 2017 Feb;23(1):165-172

    Authors: Spitaels D, Vankrunkelsven P, Desfosses J, Luyten F, Verschueren S, Van Assche D, Aertgeerts B, Hermens R

    Abstract
    RATIONALE, AIMS AND OBJECTIVES: Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated.
    METHODS: Eleven patients with knee OA were extensively interviewed using a semistructured script based on quality indicators. Directed content analysis, within the framework of Grol and Wensing, was performed to describe barriers and facilitators in 6 domains: guideline, health care professional, patient, social environment, organization, and financial context. Data were analyzed using NVIVO 10 software.
    RESULTS: In total, 38 barriers, at all 6 domains, were identified. The most frequently mentioned barriers were in the domains of the patient and the health care professional, namely, patients' disagreement with guidelines recommendations, negative experience with drugs, patients' limited comprehension of the disease process, and poor communication by the health care professional. The patients' disagreement with recommendations is further explained by the following barriers: "insistence on medical imaging," "fear that physiotherapy aggravates pain," and "perception that knee OA is not a priority health issue". Patients also reported 20 facilitators, all of which are listed as opposing barriers.
    CONCLUSIONS: Patients indicate that both personal factors and factors related to health care professionals play an important role in nonadherence. An interview script, based on quality indicators, was a significant aid to structurally formulate barriers and facilitators in the perceived knee OA care. Future guideline implementation strategies should take the identified barriers and facilitators into account.

    PMID: 27859970 [PubMed - in process]

zuletzt verändert: 04.03.2017 08:36