Aktueller Newsletter März

Stand: 3. April 2017
  1. [International guidelines from the Surviving Sepsis Campaign : 2016 update].

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    Anaesthesist. 2017 Mar 31;:

    Authors: Briegel J, Möhnle P

    Abstract
    An update to the international guidelines for sepsis therapy was published by the Surviving Sepsis Campaign (SSC) in March 2017. The guidelines have been completely restructured and comprehensively deal with new evidence. The guidelines discuss sepsis-specific therapeutic measures and provide detailed recommendations on general intensive care measures for sepsis. This article summarizes the most important amendments and suggests delving deeper into the guidelines.

    PMID: 28364305 [PubMed - as supplied by publisher]

    Briegel J, Möhnle P
  2. [Relaxation techniques and behavioural therapy for the treatment of migraine : Guidelines from the German Migraine and Headache Society].

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    Schmerz. 2017 Mar 31;:

    Authors: Kropp P, Meyer B, Dresler T, Fritsche G, Gaul C, Niederberger U, Förderreuther S, Malzacher V, Jürgens TP, Marziniak M, Straube A

    Abstract
    Besides pharmacological and interventional possibilities nonpharmacological options, deriving from behavioural approaches may be helpful in the treatment of migraine. Already consulting a patient reduces frequency of attacks. Relaxation (especially progressive muscle relaxation), endurance sports, and biofeedback as well as cognitive behavioural therapy are effective in treatment of migraine. The combination of these treatment options also with pharmacological treatment increase the positive effects.

    PMID: 28364171 [PubMed - as supplied by publisher]

    Kropp P, Meyer B, Dresler T, Fritsche G, Gaul C, Niederberger U, Förderreuther S, Malzacher V, Jürgens TP, Marziniak M, Straube A
  3. Clinicians' adherence to clinical practice guidelines for cardiac function monitoring during antipsychotic treatment: a retrospective report on 434 patients with severe mental illness.

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    BMC Psychiatry. 2017 Mar 31;17(1):121

    Authors: Manchia M, Firinu G, Carpiniello B, Pinna F

    Abstract
    BACKGROUND: Severe mental illness (SMI) has considerable excess morbidity and mortality, a proportion of which is explained by cardiovascular diseases, caused in part by antipsychotic (AP) induced QT-related arrhythmias and sudden death by Torsade de Point (TdP). The implementation of evidence-based recommendations for cardiac function monitoring might reduce the incidence of these AP-related adverse events. To investigate clinicians' adherence to cardiac function monitoring before and after starting AP, we performed a retrospective assessment of 434 AP-treated SMI patients longitudinally followed-up for 5 years at an academic community mental health center.
    METHODS: We classified antipsychotics according to their risk of inducing QT-related arrhythmias and TdP (Center for Research on Therapeutics, University of Arizona). We used univariate tests and multinomial or binary logistic regression model for data analysis.
    RESULTS: Univariate and multinomial regression analysis showed that psychiatrists were more likely to perform pre-treatment electrocardiogram (ECG) and electrolyte testing with AP carrying higher cardiovascular risk, but not on the basis of AP pharmacological class. Univariate and binomial regression analysis showed that cardiac function parameters (ECG and electrolyte balance) were more frequently monitored during treatment with second generation AP than with first generation AP.
    CONCLUSIONS: Our data show the presence of weaknesses in the cardiac function monitoring of AP-treated SMI patients, and might guide future interventions to tackle them.

    PMID: 28359306 [PubMed - in process]

    Manchia M, Firinu G, Carpiniello B, Pinna F
  4. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline.

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    J Clin Endocrinol Metab. 2017 Mar 01;102(3):709-757

    Authors: Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA

    Abstract
    Cosponsoring Associations: The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society.
    Objective: To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity.
    Participants: The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer.
    Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
    Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline.
    Conclusion: Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.

    PMID: 28359099 [PubMed - in process]

    Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA
  5. Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments.

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    PLoS One. 2017;12(3):e0174831

    Authors: Hoffmann-Eßer W, Siering U, Neugebauer EA, Brockhaus AC, Lampert U, Eikermann M

    Abstract
    INTRODUCTION: The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within 6 domains and 2 overall assessments (1. overall guideline quality; 2. recommendation for use). The aim of this systematic review was twofold. Firstly, to investigate how often AGREE II users conduct the 2 overall assessments. Secondly, to investigate the influence of the 6 domain scores on each of the 2 overall assessments.
    MATERIALS AND METHODS: A systematic bibliographic search was conducted for publications reporting guideline appraisals with AGREE II. The impact of the 6 domain scores on the overall assessment of guideline quality was examined using a multiple linear regression model. Their impact on the recommendation for use (possible answers: "yes", "yes, with modifications", "no") was examined using a multinomial regression model.
    RESULTS: 118 relevant publications including 1453 guidelines were identified. 77.1% of the publications reported results for at least one overall assessment, but only 32.2% reported results for both overall assessments. The results of the regression analyses showed a statistically significant influence of all domains on overall guideline quality, with Domain 3 (rigour of development) having the strongest influence. For the recommendation for use, the results showed a significant influence of Domains 3 to 5 ("yes" vs. "no") and Domains 3 and 5 ("yes, with modifications" vs. "no").
    CONCLUSIONS: The 2 overall assessments of AGREE II are underreported by guideline assessors. Domains 3 and 5 have the strongest influence on the results of the 2 overall assessments, while the other domains have a varying influence. Within a normative approach, our findings could be used as guidance for weighting individual domains in AGREE II to make the overall assessments more objective. Alternatively, a stronger content analysis of the individual domains could clarify their importance in terms of guideline quality. Moreover, AGREE II should require users to transparently present how they conducted the assessments.

    PMID: 28358870 [PubMed - in process]

    Hoffmann-Eßer W, Siering U, Neugebauer EA, Brockhaus AC, Lampert U, Eikermann M
  6. Did KDIGO guidelines on acute kidney injury improve patient outcome?

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    Intensive Care Med. 2017 Mar 28;:

    Authors: Lameire N, Vanmassenhove J, Lewington A

    PMID: 28352976 [PubMed - as supplied by publisher]

    Lameire N, Vanmassenhove J, Lewington A
  7. The effect of requesting a reason for non-adherence to a guideline in a long running automated reminder system for PONV prophylaxis.

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    Appl Clin Inform. 2017 Mar 29;8(1):313-321

    Authors: Kooij FO, Klok T, Preckel B, Hollmann MW, Kal JE

    Abstract
    BACKGROUND: Automated reminders are employed frequently to improve guideline adherence, but limitations of automated reminders are becoming more apparent. We studied the reasons for non-adherence in the setting of automated reminders to test the hypothesis that a separate request for a reason in itself may further improve guideline adherence.
    METHODS: In a previously implemented automated reminder system on prophylaxis for postoperative nausea and vomiting (PONV), we included additional automated reminders requesting a reason for non-adherence. We recorded these reasons in the pre-operative screening clinic, the OR and the PACU. We compared adherence to our PONV guideline in two study groups with a historical control group.
    RESULTS: Guideline adherence on prescribing and administering PONV prophylaxis (dexamethasone and granisetron) all improved compared to the historical control group (89 vs. 82% (p< 0.0001), 96 vs 95% (not significant) and 90 vs 82% (p<0.0001)) while decreasing unwarranted prescription for PONV prophylaxis (10 vs. 13 %). In the pre-operative screening clinic, the main reason for not prescribing PONV prophylaxis was disagreement with the risk estimate by the decision support system. In the OR/PACU, the main reasons for not administering PONV prophylaxis were: 'unintended non-adherence' and 'failure to document'.
    CONCLUSIONS: In this study requesting a reason for non-adherence is associated with improved guideline adherence. The effect seems to depend on the underlying reason for non-adherence. It also illustrates the importance of human factors principles in the design of decision support. Some reasons for non-adherence may not be influenced by automated reminders.

    PMID: 28352926 [PubMed - in process]

    Kooij FO, Klok T, Preckel B, Hollmann MW, Kal JE
  8. Antibiotic prescribing for acute lower respiratory tract infections (LRTI) - guideline adherence in the German primary care setting: An analysis of routine data.

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    PLoS One. 2017;12(3):e0174584

    Authors: Kraus EM, Pelzl S, Szecsenyi J, Laux G

    Abstract
    OBJECTIVES: Antibiotic overprescribing in primary care has major impacts on the development of antibiotic resistance. The objective of this study is to provide insight in antibiotics prescriptions for patients suffering from cough, acute bronchitis or community acquired pneumonia in primary care.
    METHODS: Data from 2009 to 2013 of electronic health records of 12,880 patients in Germany were obtained from a research database. The prescription of antibiotics for acute lower respiratory tract infections was compared to the national S3 guideline cough from the German Society of General Practitioners and Family Medicine.
    RESULTS: Antibiotics were prescribed in 41% of consultations. General practitioners' decision of whether or not to prescribe an antibiotic was congruent with the guideline in 52% of consultations and the antibiotic choice congruence was 51% of antibiotic prescriptions. Hence, a congruent prescribing decision and a prescription of recommendation was found in only 25% of antibiotic prescriptions. Split by diagnosis we found that around three quarters of antibiotics prescribed for cough (73%) and acute bronchitis (78%) were not congruent to the guidelines. In contrast to that around one quarter of antibiotics prescribed for community acquired pneumonia (28%) were not congruent to the guidelines.
    CONCLUSIONS: Our results show that there is a big gap between guideline recommendation and actual prescribing, in the decision to prescribe and the choice of antibiotic agent. This gap could be closed by periodic quality circles on antibiotic prescribing for GPs.

    PMID: 28350820 [PubMed - in process]

    Kraus EM, Pelzl S, Szecsenyi J, Laux G
  9. Molecular Biomarkers for the Evaluation of Colorectal Cancer: Guideline Summary From the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology.

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    J Oncol Pract. 2017 Mar 28;:JOP2017022152

    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

    PMID: 28350513 [PubMed - as supplied by publisher]

    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
  10. Treatment of gonorrhoea in Auckland, New Zealand: marked variation in prescriber adherence to treatment guidelines.

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    Intern Med J. 2017 Mar 27;:

    Authors: Forster R, Ng MD, Upton A, Franklin R, Thomas M

    Abstract
    BACKGROUND: The relentless emergence and spread of strains of Neisseria gonorrhoeae that are resistant to many antimicrobial agents has led to frequent changes in treatment guidelines, with a consequent risk that prescribers may not be aware of current guidelines.
    METHODS: We audited the treatment given to adult patients with laboratory proven gonorrhoea in Auckland, New Zealand, during the first six months of 2015.
    RESULTS: Treatment compliant with the current New Zealand Sexual Health Society (NZSHS) guidelines was administered in only 65% (458/706) episodes overall. Guideline compliant treatment was much more likely to be prescribed for patients who presented to a sexual health clinic (89%), than for patients who presented to either a general practice or other community clinic (52%), or to a hospital (56%)(P<0.0001). Overall 52/706 (7%) episodes were not treated with any antimicrobial regimen by the service that diagnosed the patients' gonorrhoea; 13/62 (21%) episodes in patients who presented to a hospital, 34/403 (8%) episodes in patients who presented to a general practice or other community clinic, and 5/241 (2%) episodes in patients who presented to a sexual health clinic (P<0.0001).
    CONCLUSIONS: Low levels of compliance with treatment guidelines increase the risk that antibiotic resistant strains of N. gonorrhoeae will spread within the Auckland region. Improved compliance with treatment guidelines, particularly in patients who present either to general practice or to hospitals, is necessary to maintain the efficacy of current treatment regimens.

    PMID: 28345188 [PubMed - as supplied by publisher]

    Forster R, Ng MD, Upton A, Franklin R, Thomas M
  11. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU).

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    United European Gastroenterol J. 2017 Mar;5(2):153-199

    Authors: Löhr JM, Dominguez-Munoz E, Rosendahl J, Besselink M, Mayerle J, Lerch MM, Haas S, Akisik F, Kartalis N, Iglesias-Garcia J, Keller J, Boermeester M, Werner J, Dumonceau JM, Fockens P, Drewes A, Ceyhan G, Lindkvist B, Drenth J, Ewald N, Hardt P, de Madaria E, Witt H, Schneider A, Manfredi R, Brøndum FJ, Rudolf S, Bollen T, Bruno M, HaPanEU/UEG Working Group

    Abstract
    BACKGROUND: There have been substantial improvements in the management of chronic pancreatitis, leading to the publication of several national guidelines during recent years. In collaboration with United European Gastroenterology, the working group on 'Harmonizing diagnosis and treatment of chronic pancreatitis across Europe' (HaPanEU) developed these European guidelines using an evidence-based approach.
    METHODS: Twelve multidisciplinary review groups performed systematic literature reviews to answer 101 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation system and the answers were assessed by the entire group in a Delphi process online. The review groups presented their recommendations during the 2015 annual meeting of United European Gastroenterology. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting (Test and Evaluation Directorate). After a final round of adjustments based on these comments, a draft version was sent out to external reviewers.
    RESULTS: The 101 recommendations covered 12 topics related to the clinical management of chronic pancreatitis: aetiology (working party (WP)1), diagnosis of chronic pancreatitis with imaging (WP2 and WP3), diagnosis of pancreatic exocrine insufficiency (WP4), surgery in chronic pancreatitis (WP5), medical therapy (WP6), endoscopic therapy (WP7), treatment of pancreatic pseudocysts (WP8), pancreatic pain (WP9), nutrition and malnutrition (WP10), diabetes mellitus (WP11) and the natural course of the disease and quality of life (WP12). Using the Grading of Recommendations Assessment, Development and Evaluation system, 70 of the 101 (70%) recommendations were rated as 'strong' and plenary voting revealed 'strong agreement' for 99 (98%) recommendations.
    CONCLUSIONS: The 2016 HaPanEU/United European Gastroenterology guidelines provide evidence-based recommendations concerning key aspects of the medical and surgical management of chronic pancreatitis based on current available evidence. These recommendations should serve as a reference standard for existing management of the disease and as a guide for future clinical research.

    PMID: 28344786 [PubMed - in process]

    Löhr JM, Dominguez-Munoz E, Rosendahl J, Besselink M, Mayerle J, Lerch MM, Haas S, Akisik F, Kartalis N, Iglesias-Garcia J, Keller J, Boermeester M, Werner J, Dumonceau JM, Fockens P, Drewes A, Ceyhan G, Lindkvist B, Drenth J, Ewald N, Hardt P, de Madaria E, Witt H, Schneider A, Manfredi R, Brøndum FJ, Rudolf S, Bollen T, Bruno M, HaPanEU/UEG Working Group
  12. Understanding Dutch practice nurses' adherence to evidence-based smoking cessation guidelines and their needs for web-based adherence support: results from semistructured interviews.

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    BMJ Open. 2017 Mar 22;7(3):e014154

    Authors: de Ruijter D, Smit ES, de Vries H, Goossens L, Hoving C

    Abstract
    OBJECTIVES: Practice nurses in general practices suboptimally adhere to smoking cessation guidelines. Since the effectiveness of their smoking cessation support is greatest when full adherence to these guidelines is achieved, interventions need to be developed to improve practice nurses' guideline adherence, for example, by tailoring their content to adherence determinants. However, the sociocognitive determinants explaining adherence have not yet been investigated. Therefore, this qualitative needs assessment aimed to explore practice nurses' current counselling practices, as well as their sociocognitive beliefs related to their smoking cessation guideline adherence and their needs regarding web-based adherence support.
    SETTING: Primary care; general practices in the Netherlands.
    PARTICIPANTS: 19 practice nurses, actively involved in smoking cessation counselling.
    METHODS: Semistructured individual interviews, based on the I-Change Model and the Diffusion of Innovations Theory, were conducted from May to September 2014. Data were systematically analysed using the Framework Method and considered reliable (κ 0.77; % agreement 99%).
    RESULTS: Respondents felt able to be empathic and collaborative during smoking cessation consultations. They also reported psychological (eg, low self-efficacy to increase patient motivation and arranging adequate follow-up consultations) and practical barriers (eg, outdated information on quit support compensation and a perceived lack of high-quality trainings for practice nurses) to smoking cessation guideline adherence. Most respondents were interested in web-based adherence support to overcome these barriers.
    CONCLUSIONS: Sociocognitive determinants influence practice nurses' smoking cessation guideline adherence. To improve their adherence, web-based tailored adherence support can provide practice nurses with personally relevant feedback tailored to individually perceived barriers to smoking cessation guideline adherence. More specifically, low self-efficacy levels can be increased by peer modelling (eg, presenting narratives of colleagues) and up-to-date information can be presented online, enabling practice nurses to use it during patient consultations, resulting in more effective communication with their smoking patients.
    TRIAL REGISTRATION NUMBER: NTR4436; Pre-results.

    PMID: 28336746 [PubMed - in process]

    de Ruijter D, Smit ES, de Vries H, Goossens L, Hoving C
  13. Evaluating the effects of organizational and educational interventions on adherence to clinical practice guidelines in a low-resource primary-care setting in Kenya.

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    Health Policy Plan. 2017 Mar 15;:

    Authors: Egger JR, Stankevitz K, Korom R, Angwenyi P, Sullivan B, Wang J, Hatfield S, Smith E, Popli K, Gross J

    Abstract
    Background: Mid-level care providers serve as the backbone of primary care in many parts of sub-Saharan Africa. Despite this, research suggests that the quality and consistency of this care is uneven. This study assessed the degree to which a set of four simple, low-cost interventions could improve adherence to a set of clinical quality measures (CQMs) associated with four common health conditions seen in a resource-constrained primary care setting.
    Methods: A quasi-experimental, longitudinal study was carried out in three primary care clinics in Nairobi, Kenya from August 2014 to January, 2015. Mid-level clinical officers (COs) at each clinic participated in four interventions aimed at improving CQM adherence. A group of temporary COs acted as a control group. Clinical encounter data were abstracted from eligible medical charts and assessed for CQM adherence. Mixed-effects logistic regression models were then fitted to these data to determine whether adherence to CQMs improved over time, and if this adherence differed by provider type and other characteristics.
    Results: Adherence to CQMs increased from 41.4% to 77.1% for COs that took part in the intervention, and dropped slightly from 26.5% to 21.8% for temporary COs over the 6-month study period. This difference was statistically different between treatment groups and suggests that environmental interventions alone cannot change behaviour. Adherence also varied significantly by health condition, but did not vary by provider gender, age or clinic site.
    Conclusions: This study demonstrates the potential for low-tech, low-cost interventions to improve the quality of care delivered by mid-level care providers in resource-constrained settings. Given the widespread utilization of mid-level care providers across sub-Saharan Africa, multicomponent interventions such as this one, that consist of simple educational modules and clinic-based feedback sessions, could lead to substantial improvements in the quality of primary care in these settings.

    PMID: 28334856 [PubMed - as supplied by publisher]

    Egger JR, Stankevitz K, Korom R, Angwenyi P, Sullivan B, Wang J, Hatfield S, Smith E, Popli K, Gross J
  14. Implementing guidelines for preventing, identifying and treating adolescent overweight and obesity; - school nurses' perceptions of the challenges involved.

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    J Clin Nurs. 2017 Mar 23;:

    Authors: Helseth S, Riiser K, Holmberg Fagerlund B, Misvaer N

    Abstract
    AIMS AND OBJECTIVES: We aimed to gain a better understanding of school nurses' perceptions of the challenges involved in implementing national guidelines on managing overweight and obesity in adolescents.
    BACKGROUND: National guidelines for the management of childhood overweight and obesity are developed in many countries to translate scientific knowledge into practice. However, several challenges are involved in their implementation.
    DESIGN AND METHODS: A qualitative design with focus group interviews was chosen for data collection. Six focus group interviews with 21 school nurses were conducted. Data were analyzed by qualitative content analyses.
    RESULTS: National guidelines provided new directions for managing overweight and obesity in school health services. School nurses were assigned new tasks and responsibilities, which they felt they were not sufficiently prepared for, nor were they supported by extra resources. Challenges in implementation of the guidelines were identified at various levels: system level (implementation strategy, available resources, training and support, professional collaboration, referral options); individual school nurse level (perceived competence, burden of responsibility, attitudes and emotions); subject level (sensitivity of weight-related issues); and professional level (skepticism to a BMI cutoff of 25 kg/m(2) as the starting point for intervention).
    CONCLUSIONS: School nurses felt overwhelmed in terms of implementing the guidelines. This indicates barriers not being sufficiently identified or acted upon during implementation. Further, the nurses' skepticism about the BMI cutoff for intervention, and their experience that measuring and follow-up of adolescents' weight development was their responsibility alone, indicate that important discussions are needed on this as an adequate measure as well as on the professional division of responsibilities.
    RELEVANCE TO CLINICAL PRACTICE: Having a proper strategy for implementation, and ensuring that necessary clinical structures and resources are available, is crucial. Including school nurses in developing and implementing such strategies is vital for success in implementing national guidelines. This article is protected by copyright. All rights reserved.

    PMID: 28334476 [PubMed - as supplied by publisher]

    Helseth S, Riiser K, Holmberg Fagerlund B, Misvaer N
  15. Adherence to Celiac Disease and Eosinophilic Esophagitis Biopsy Guidelines is Poor in Children.

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    J Pediatr Gastroenterol Nutr. 2017 Mar 22;:

    Authors: Wallach T, Genta RM, Lebwohl B, Green PH, Reilly NR

    Abstract
    OBJECTIVES: Celiac disease (CD) and eosinophilic esophagitis (EoE) are underdiagnosed gastrointestinal conditions which adversely impact children's health. Prior studies have shown that diagnostic guidelines for CD are not consistently followed in adults. The aims of this study are to assess the frequency with which endoscopists comply with diagnostic guidelines for CD and EoE in children, and to determine whether an association exists between adherence to biopsy guidelines and disease detection in pediatric patients.
    METHODS: We reviewed pathology reports from 9171 children (ages 0-18) with at least one duodenal biopsy, and 8280 children with at least one esophageal biopsy, with specimens submitted to a national pathology laboratory. Frequency of adherence to diagnostic guidelines and recommendations for CD and EoE were determined, as well as the impact of this upon detection of CD and EoE.
    RESULTS: Overall, 35% of cases were biopsied according to the 2006 American Gastroenterological Association (AGA) guidelines for CD diagnosis; 8% were biopsied according to the 2007 AGA EoE consensus recommendations. Detection of CD and EoE increased with the number of biopsies collected (p for trend in each < 0.001). Adherence to diagnostic guidelines was particularly poor among those found to have histologically normal mucosa in both cohorts. The likelihood of CD and EoE diagnosis was significantly associated with adherence to diagnostic guidelines (OR for CD 6.3, 95% CI 4.4-8.9; OR for EoE 2.4, 95% CI 1.9-2.9).
    CONCLUSIONS: Adherence to established guidelines is poor, and improved guideline adherence is associated with greater disease detection rates for CD and EoE.

    PMID: 28333765 [PubMed - as supplied by publisher]

    Wallach T, Genta RM, Lebwohl B, Green PH, Reilly NR
  16. The value of theory in programmes to implement clinical guidelines: Insights from a retrospective mixed-methods evaluation of a programme to increase adherence to national guidelines for chronic disease in primary care.

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    PLoS One. 2017;12(3):e0174086

    Authors: Sheringham J, Solmi F, Ariti C, Baim-Lance A, Morris S, Fulop NJ

    Abstract
    BACKGROUND: Programmes have had limited success in improving guideline adherence for chronic disease. Use of theory is recommended but is often absent in programmes conducted in 'real-world' rather than research settings.
    MATERIALS AND METHODS: This mixed-methods study tested a retrospective theory-based approach to evaluate a 'real-world' programme in primary care to improve adherence to national guidelines for chronic obstructive pulmonary disease (COPD). Qualitative data, comprising analysis of documents generated throughout the programme (n>300), in-depth interviews with planners (clinicians, managers and improvement experts involved in devising, planning, and implementing the programme, n = 14) and providers (practice clinicians, n = 14) were used to construct programme theories, experiences of implementation and contextual factors influencing care. Quantitative analyses comprised controlled before-and-after analyses to test 'early' and evolved' programme theories with comparators grounded in each theory. 'Early' theory predicted the programme would reduce emergency hospital admissions (EHA). It was tested using national analysis of standardized borough-level EHA rates between programme and comparator boroughs. 'Evolved' theory predicted practices with higher programme participation would increase guideline adherence and reduce EHA and costs. It was tested using a difference-in-differences analysis with linked primary and secondary care data to compare changes in diagnosis, management, EHA and costs, over time and by programme participation.
    RESULTS: Contrary to programme planners' predictions in 'early' and 'evolved' programme theories, admissions did not change following the programme. However, consistent with 'evolved' theory, higher guideline adoption occurred in practices with greater programme participation.
    CONCLUSIONS: Retrospectively constructing theories based on the ideas of programme planners can enable evaluators to address some limitations encountered when evaluating programmes without a theoretical base. Prospectively articulating theory aided by existing models and mid-range implementation theories may strengthen guideline adoption efforts by prompting planners to scrutinise implementation methods. Benefits of deriving programme theory, with or without the aid of mid-range implementation theories, however, may be limited when the evidence underpinning guidelines is flawed.

    PMID: 28328942 [PubMed - in process]

    Sheringham J, Solmi F, Ariti C, Baim-Lance A, Morris S, Fulop NJ
  17. Improving the adaptability of WHO evidence-informed guidelines for nutrition actions: results of a mixed methods evaluation.

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    Implement Sci. 2017 Mar 21;12(1):39

    Authors: Dedios MC, Esperato A, De-Regil LM, Peña-Rosas JP, Norris SL

    Abstract
    BACKGROUND: Over the past decade, the World Health Organization (WHO) has implemented a standardized, evidence-informed guideline development process to assure technically sound and policy-relevant guidelines. This study is an independent evaluation of the adaptability of the guidelines produced by the Evidence and Programme Guidance unit, at the Department of Nutrition for Health and Development (NHD). The study systematizes the lessons learned by the NHD group at WHO.
    METHODS: We used a mixed methods approach to determine the adaptability of the nutrition guidelines. Adaptability was defined as having two components; methodological quality and implementability of guidelines. Additionally, we gathered recommendations to improve future guideline development in nutrition actions for health and development. Data sources for this evaluation were official documentation and feedback (both qualitative and quantitative) from key stakeholders involved in the development of nutrition guidelines. The qualitative data was collected through a desk review and two waves of semi-structured interviews (n = 12) and was analyzed through axial coding. Guideline adaptability was assessed quantitatively using two standardized instruments completed by key stakeholders. The Appraisal Guideline for Research and Evaluation questionnaire, version II was used to assess guideline quality (n = 6), while implementability was assessed with the electronic version of the GuideLine Implementability Appraisal (n = 7).
    RESULTS: The nutrition evidence-informed guideline development process has several strengths, among them are the appropriate management of conflicts of interest of guideline developers and the systematic use of high-quality evidence to inform the recommendations. These features contribute to increase the methodological quality of the guidelines. The key areas for improvement are the limited implementability of the recommendations, the lack of explicit and precise implementation advice in the guidelines and challenges related to collaborative work within interdisciplinary groups.
    CONCLUSIONS: Overall, our study found that the nutrition evidence-informed guidelines are of good methodological quality but that the implementability requires improvement. The recommendations to improve guideline adaptability address the guideline content, the dynamics shaping interdisciplinary work, and actions for implementation feasibility. As WHO relies heavily on a standardized procedure to develop guidelines, the lessons learned may be applicable to guideline development across the organization and to other groups developing guidelines.

    PMID: 28327198 [PubMed - in process]

    Dedios MC, Esperato A, De-Regil LM, Peña-Rosas JP, Norris SL
  18. Guidelines implementation, professionalism and future of our specialty - hidden link?

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    Minerva Anestesiol. 2017 Mar 22;:

    Authors: Cerny V, Rogozov V

    PMID: 28326757 [PubMed - as supplied by publisher]

    Cerny V, Rogozov V
  19. Low back pain and sciatica in over 16s: assessment and management NICE Guideline [NG59].

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    J Physiother. 2017 Mar 07;:

    Authors: de Campos TF

    PMID: 28325480 [PubMed - as supplied by publisher]

    de Campos TF
  20. Imaging tissue-mimic with light sheet microscopy: A comparative guideline.

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    Sci Rep. 2017 Mar 21;7:44939

    Authors: Andilla J, Jorand R, Olarte OE, Dufour AC, Cazales M, Montagner YL, Ceolato R, Riviere N, Olivo-Marin JC, Loza-Alvarez P, Lorenzo C

    Abstract
    Tissue mimics (TMs) on the scale of several hundred microns provide a beneficial cell culture configuration for in vitro engineered tissue and are currently under the spotlight in tissue engineering and regenerative medicine. Due to the cell density and size, TMs are fairly inaccessible to optical observation and imaging within these samples remains challenging. Light Sheet Fluorescence Microscopy (LSFM)- an emerging and attractive technique for 3D optical sectioning of large samples- appears to be a particularly well-suited approach to deal with them. In this work, we compared the effectiveness of different light sheet illumination modalities reported in the literature to improve resolution and/or light exposure for complex 3D samples. In order to provide an acute and fair comparative assessment, we also developed a systematic, computerized benchmarking method. The outcomes of our experiment provide meaningful information for valid comparisons and arises the main differences between the modalities when imaging different types of TMs.

    PMID: 28322312 [PubMed - in process]

    Andilla J, Jorand R, Olarte OE, Dufour AC, Cazales M, Montagner YL, Ceolato R, Riviere N, Olivo-Marin JC, Loza-Alvarez P, Lorenzo C
  21. Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments' providers.

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    Int J Emerg Med. 2017 Dec;10(1):11

    Authors: Zee-Cheng JE, Webber EC, Abu-Sultaneh S

    Abstract
    BACKGROUND: Diabetic ketoacidosis (DKA) is a common presentation of type I diabetes mellitus to the emergency departments. Most children with DKA are initially managed in community emergency departments where providers may not have easy access to educational resources or pediatric-specific guidelines and protocols that are readily available at pediatric academic medical centers. The aim of this study is to evaluate adherence of community emergency departments in the state of Indiana to the pediatric DKA guidelines.
    METHODS: We performed a retrospective chart review of patients, age 18 years of age or under, admitted to the pediatric intensive care unit with a diagnosis of DKA.
    RESULTS: A total of 100 patients were included in the analysis. Thirty-seven percent of patients with DKA were managed according to all six guideline parameters. Only 39% of patients received the recommended hourly blood glucose checks. Thirty percent of patients received intravenous insulin bolus, which is not recommended.
    CONCLUSIONS: Non-adherence to pediatric DKA guidelines still exists in the state of Indiana. Further, larger studies are needed to reveal the etiology of non-adherence to pediatric DKA guidelines and strategies to improve that adherence.

    PMID: 28321786 [PubMed - in process]

    Zee-Cheng JE, Webber EC, Abu-Sultaneh S
  22. [New ESC heart failure guideline - significance for general practitioners.]

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    MMW Fortschr Med. 2017 Mar;159(5):43-46

    Authors: Tröbs M, Achenbach S

    PMID: 28321728 [PubMed - in process]

    Tröbs M, Achenbach S
  23. Utilizing Behavior Change Techniques to Elicit Adherence to Clinical Practice Guidelines.

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    Front Public Health. 2017;5:37

    Authors: Ferreira D

    Abstract
    INTRODUCTION: Two 2-day continuing education seminars were developed to address the orthopedic physical therapy deficits in Guyana. Material was presented in a way to address all stages of behavior change.
    METHODS: Surveys evaluating preseminar and postseminar knowledge was conducted. Chart reviews to establish adherence to clinical practice guidelines were performed.
    RESULTS: Preseminar surveys revealed minimal knowledge of clinical practice guidelines, which was consistent with preseminar chart review data. Postseminar data indicate improvements in both knowledge and adherence to guidelines.
    DISCUSSION: A brief series of two 2-day seminars utilizing behavior change strategies to improve adherence to clinical practice guidelines shows promise for countries and regions that rely on international health volunteers to provide clinical instruction. Because this study is limited to one situation, further studies with longer follow-up in a variety of clinical settings are recommended to support generalizability of findings.

    PMID: 28321392 [PubMed - in process]

    Ferreira D
  24. Adherence to national exercise guidelines by patients attending emergency departments: A multi-site survey.

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    Emerg Med Australas. 2017 Mar 20;:

    Authors: Berlingeri P, Cunningham N, Taylor DM, Knott J, McLean D, Gavan R, Plant L, Chen H, Weiland T

    Abstract
    OBJECTIVE: The proportion of adults in Australia meeting or exceeding the national guidelines for physical activity has remained relatively static over the past 10 years. The research objective was to measure self-reported physical activity and sedentary behaviour among ED patients in accordance with Australia's current physical activity and sedentary behaviour guidelines, revised in 2014.
    METHODS: A convenience sample of participants was recruited from three EDs in Melbourne between February and May 2016. Eligible participants were administered the International Physical Activity Questionnaire - Short Form plus researcher-derived questions. Participants were assessed as whether meeting the physical activity guidelines or not, using pre-defined criteria.
    RESULTS: The proportion of 18-64 year olds meeting all of the physical activity guidelines was 19.0% (95% confidence interval [CI] 15.2-22.8). A majority of participants (63.1%, 95% CI 58.5-67.7) met the aerobic component of the guidelines although only 28.9% (95% CI 24.5-33.3) of participants reported undertaking strength building exercises two or more times per week. Adults in the oldest age group were found to be less likely to engage in muscle strengthening exercises (23.3%, n = 30) than those in the youngest age group (40.0%, n = 60, P = 0.005). Average daily sitting time (minutes) did not differ between men (median = 300) and women (median = 360, P = 0.118).
    CONCLUSIONS: Overall adherence with physical activity guidelines is low among adults attending the ED. All adults need to be encouraged to undertake muscle strengthening activities, especially adults in older age groups.

    PMID: 28320071 [PubMed - as supplied by publisher]

    Berlingeri P, Cunningham N, Taylor DM, Knott J, McLean D, Gavan R, Plant L, Chen H, Weiland T
  25. Are diabetes guidelines truly evidence based?

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    Diabetes Res Clin Pract. 2017 Mar 07;127:70-79

    Authors: Bouchonville MF, Matani S, DuBroff JJ, DuBroff RJ

    Abstract
    The global epidemic of obesity and diabetes underscores the urgency to develop strategies to prevent cardiovascular (CV) disease in this vulnerable population. Clinical guidelines are intended to help the clinician manage these patients, but guidelines are often discordant among professional organizations and not always evidence based. Clinicians must rely upon the best available evidence, and therefore we critically reviewed the evidence behind the American Diabetes Association (ADA) 2016 guidelines on the prevention of CV disease in diabetes. We believe the most robust evidence comes from randomized controlled trials specifically designed for diabetes with hard clinical endpoints such as mortality and CV events. Our analysis supports the ADA recommendations regarding a Mediterranean diet, glycemic control, and BP control, but we believe the evidence to support aspirin and statin therapy in diabetes is inconclusive. This discordance may be multi-factorial including the exclusion of some relevant studies and an over-reliance upon subgroup and meta-analysis. Given the lack of mortality benefit and inconsistent clinical benefits of aspirin and statins, it is essential that clinicians individualize treatment decisions while carefully weighing the risks and harms of any intervention.

    PMID: 28319804 [PubMed - as supplied by publisher]

    Bouchonville MF, Matani S, DuBroff JJ, DuBroff RJ
  26. Recommendations for patient engagement in guideline development panels: A qualitative focus group study of guideline-naïve patients.

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    PLoS One. 2017;12(3):e0174329

    Authors: Armstrong MJ, Mullins CD, Gronseth GS, Gagliardi AR

    Abstract
    BACKGROUND: Patient and consumer engagement in clinical practice guideline development is internationally advocated, but limited research explores mechanisms for successful engagement.
    OBJECTIVE: To investigate the perspectives of potential patient/consumer guideline representatives on topics pertaining to engagement including guideline development group composition and barriers to and facilitators of engagement.
    SETTING AND PARTICIPANTS: Participants were guideline-naïve volunteers for programs designed to link community members to academic research with diverse ages, gender, race, and degrees of experience interacting with health care professionals.
    METHODS: Three focus groups and one key informant interview were conducted and analyzed using a qualitative descriptive approach.
    RESULTS: Participants recommended small, diverse guideline development groups engaging multiple patient/consumer stakeholders with no prior relationships with each other or professional panel members. No consensus was achieved on the ideal balance of patient/consumer and professional stakeholders. Pre-meeting reading/training and an identified contact person were described as keys to successful early engagement; skilled facilitators, understandable speech and language, and established mechanisms for soliciting patient opinions were suggested to enhance engagement at meetings.
    CONCLUSIONS: Most suggestions for effective patient/consumer engagement in guidelines require forethought and planning but little additional expense, making these strategies easily accessible to guideline developers desiring to achieve more meaningful patient and consumer engagement.

    PMID: 28319201 [PubMed - in process]

    Armstrong MJ, Mullins CD, Gronseth GS, Gagliardi AR
  27. Evaluation of the 2015 AGA guidelines on pancreatic cystic neoplasms in a large surgically confirmed multicenter cohort.

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    Endosc Int Open. 2017 Mar;5(3):E201-E208

    Authors: Ge PS, Muthusamy VR, Gaddam S, Jaiyeola DM, Kim S, Sedarat A, Donahue TR, Hosford L, Wilson RH, Grande DP, Keswani RN, Kushnir VM, Mullady D, Edmundowicz SA, Early DS, Komanduri S, Wani S, Watson RR

    Abstract
    Background and study aims The American Gastroenterological Association (AGA) recently published guidelines for the management of asymptomatic pancreatic cystic neoplasms (PCNs). We aimed to evaluate the diagnostic characteristics of the AGA guidelines in appropriately recommending surgery for malignant PCNs. Patients and methods A retrospective multicenter study was performed of patients who underwent endoscopic ultrasound (EUS) for evaluation of PCNs who ultimately underwent surgical resection from 2004 - 2014. Demographics, EUS characteristics, fine-needle aspiration (FNA) results, type of resection, and final pathologic diagnosis were recorded. Patients were categorized into 2 groups (surgery or surveillance) based on what the AGA guidelines would have recommended. Performance characteristics for the diagnosis of cancer or high-grade dysplasia (HGD) on surgical pathology were calculated. Results Three hundred patients underwent surgical resection for PCNs, of whom the AGA guidelines would have recommended surgery in 121 (40.3 %) and surveillance in 179 (59.7 %) patients. Among patients recommended for surgery, 45 (37.2 %) had cancer, whereas 76 (62.8 %) had no cancer/HGD. Among patients recommended for surveillance, 170 (95.0 %) had no cancer/HGD; however, 9 (5.0 %) patients had cancer that would have been missed. For the finding of cancer/HGD on surgical pathology, the AGA guidelines had 83.3 % sensitivity (95 % CI 70.7 - 92.1), 69.1 % specificity (95 % CI 62.9 - 74.8), 37.2 % positive predictive value (95 % CI 28.6 - 46.4), 95.0 % negative predictive value (95 % CI 90.7 - 97.7), and 71.7 % accuracy (95 % CI 67.4 - 74.6). Conclusions The 2015 AGA guidelines would have resulted in 60 % fewer patients being referred for surgical resection, and accurately recommended surveillance in 95 % of patients with asymptomatic PCNs. Future prospective studies are required to validate these guidelines. Meeting presentations: Presented in part at Digestive Diseases Week 2016.

    PMID: 28317015 [PubMed - in process]

    Ge PS, Muthusamy VR, Gaddam S, Jaiyeola DM, Kim S, Sedarat A, Donahue TR, Hosford L, Wilson RH, Grande DP, Keswani RN, Kushnir VM, Mullady D, Edmundowicz SA, Early DS, Komanduri S, Wani S, Watson RR
  28. Meeting the challenge of the Psychonomic Society's 2012 Guidelines on Statistical Issues: Some success and some room for improvement.

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    Psychon Bull Rev. 2017 Mar 17;:

    Authors: Morris PE, Fritz CO

    Abstract
    The Psychonomic Society (PS) adopted New Statistical Guidelines for Journals of the Psychonomic Society in November 2012. To evaluate changes in statistical reporting within and outside PS journals, we examined all empirical papers published in PS journals and in the Experimental Psychology Society journal, The Quarterly Journal of Experimental Psychology (QJEP), in 2013 and 2015, to describe these populations before and after effects of the Guidelines. Comparisons of the 2013 and 2015 PS papers reveal differences associated with the Guidelines, and QJEP provides a baseline of papers to reflect changes in reporting that are not directly influenced by the Guidelines. A priori power analyses increased from 5% to 11% in PS papers, but not in QJEP papers (2%). The reporting of effect sizes in PS papers increased from 61% to 70%, similar to the increase for QJEP from 58% to 71%. Only 18% of papers reported confidence intervals (CIs) for means; only two PS papers in 2015 reported CIs for effect sizes. Although variability statistics are important to understanding data, and to further analysis, they were only reported as numbers in just over half of the PS journal papers. Almost all PS and QJEP papers relied exclusively on null hypothesis significance testing to guide interpretation of the data. Changes associated with the Guidelines are in the desired direction with respect to reporting effect sizes and power analyses but are not yet reflected in researchers' practices in describing their data, addressing data assumptions, and thinking beyond the p value when interpreting their data.

    PMID: 28315170 [PubMed - as supplied by publisher]

    Morris PE, Fritz CO
  29. [Neuro-urological diagnosis and therapy of lower urinary tract dysfunction in patients with spinal cord injury : S2k Guideline of the German-Speaking Medical Society of Paraplegia (DMGP), AWMF register no. 179/001].

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    Urologe A. 2017 Mar 17;:

    Authors: Böthig R, Domurath B, Kaufmann A, Bremer J, Vance W, Kurze I

    Abstract
    BACKGROUND: Most patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD), bowel dysfunction and sexual dysfunction. If these remain untreated, severe medical complications and serious limitations (restrictions) in quality of life are imminent.
    OBJECTIVES: In the long term, there are considerable differences in the treatment results of highly specialized centers versus other treatment facilities.
    MATERIALS AND METHODS: Against this background, a consensus-based guideline, according to the AWMF (Association of the Scientific Medical Societies in Germany) criteria (S2k), was developed by the neuro-urology working group of the DMPG (German-Speaking Medical Society of Paraplegia).
    RESULTS: The guideline defines the principles and objectives of the neuro-urological care of patients with SCI and discusses in detail the principles of diagnosis and therapy of NLUTD. The need for video-urodynamic studies as a basis for the classification of the NLUTD and as a foundation for the development of a treatment strategy is emphasized. Both conservative and surgical therapy options and their indications are explained in detail. Possible complications and their prevention in the long-term course of SCI are presented with a particular consideration of the specific features of urinary tract infections and autonomic dysreflexia. Finally, the principles of the provision of urological appliances are discussed.
    CONCLUSIONS: The presented S2k guideline provides the current standards in the neuro-urological care of patients with NLUTD due to SCI. Their consistent implementation both in the acute and chronic phase as well as in the context of lifelong surveillance of SCI patients should prevent the impending complications of NLUTD.

    PMID: 28314966 [PubMed - as supplied by publisher]

    Böthig R, Domurath B, Kaufmann A, Bremer J, Vance W, Kurze I
  30. Effect of 2013 ACC/AHA Blood Cholesterol Guidelines on Statin Treatment Patterns and Low-Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Patients.

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    J Am Heart Assoc. 2017 Mar 17;6(3):

    Authors: Okerson T, Patel J, DiMario S, Burton T, Seare J, Harrison DJ

    Abstract
    BACKGROUND: Preceding release of the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guidelines, prescribers aimed for specific low-density lipoprotein cholesterol (LDL-C) goals in patients with atherosclerotic cardiovascular disease (ASCVD). The 2013 guidelines changed this focus to treating patients with appropriate statin intensity given their ASCVD risk. We examined statin use and LDL-C levels before and after the 2013 ACC/AHA guidelines in patients with clinical ASCVD as defined in the guidelines.
    METHODS AND RESULTS: We conducted a retrospective cohort study of adult commercial and Medicare Advantage health plan enrollees in the Optum Research Database. Patients had ≥1 claim with a diagnosis of clinical ASCVD between November 1, 2012 and December 31, 2014 and were continuously enrolled 6 months before (baseline) and 7 months after (follow-up) the first ASCVD visit. Patients were assigned to monthly cohorts based on ASCVD event month. Statin use and intensity were measured at baseline and first month of follow-up. LDL-C changes were assessed using ordinary least squares regression. For 90 287 patients, mean (SD) age was 68 (12) years; 50% were female; and 30% had commercial insurance. Statin use remained consistent before and after guidelines (32% and 31%, respectively). Of patients receiving statins, high-intensity use increased by 4 percentage points 1 year after guidelines (P<0.001). Mean LDL-C levels were 2.4 mmol/L (94 mg/dL) both pre- and postguidelines.
    CONCLUSIONS: Statin use and mean monthly LDL-C before and after the guidelines remained largely unchanged; statin intensity increased modestly. More effort may be needed to increase guideline understanding and adherence to improve treatment of high-risk patients.

    PMID: 28314797 [PubMed - in process]

    Okerson T, Patel J, DiMario S, Burton T, Seare J, Harrison DJ
  31. Impact of implementing electronic clinical practice guidelines for the diagnosis, control and treatment of cardiovascular risk factors: A pre-post controlled study.

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    Aten Primaria. 2017 Mar 14;:

    Authors: Comin E, Catalan-Ramos A, Iglesias-Rodal M, Grau M, Del Val JL, Consola A, Amado E, Pons A, Mata-Cases M, Franzi A, Ciurana R, Frigola E, Cos X, Davins J, Verdu-Rotellar JM

    Abstract
    OBJECTIVE: To evaluate the impact of computerized clinical practice guidelines on the management, diagnosis, treatment, control, and follow-up of the main cardiovascular risk factors: hypertension, hypercholesterolaemia, and type 2 diabetes mellitus.
    DESIGN: Pre-post controlled study.
    SETTING: Catalonia, autonomous community located in north-eastern Spain.
    PARTICIPANTS: Individuals aged 35-74 years assigned to general practitioners of the Catalan Health Institute.
    INTERVENTION: The intervention group consisted of individuals whose general practitioners had accessed the computerized clinical practice guidelines at least twice a day, while the control group consisted of individuals whose general practitioner had never accessed the computerized clinical practice guidelines platform.
    MAIN OUTCOMES: The Chi-squared test was used to detect significant differences in the follow-up, control, and treatment variables for all three disorders (hypertension, hypercholesterolaemia, and type 2 diabetes mellitus) between individuals assigned to users and non-users of the computerized clinical practice guidelines, respectively.
    RESULTS: A total of 189,067 patients were included in this study, with a mean age of 56 years (standard deviation 12), and 55.5% of whom were women. Significant differences were observed in hypertension management, treatment and control; type 2 diabetes mellitus management, treatment and diagnoses, and the management and control of hypercholesterolaemia in both sexes.
    CONCLUSIONS: Computerized clinical practice guidelines are an effective tool for the control and follow-up of patients diagnosed with hypertension, type 2 diabetes mellitus, and hypercholesterolaemia. The usefulness of computerized clinical practice guidelines to diagnose and adequately treat individuals with these disorders remains unclear.

    PMID: 28314542 [PubMed - as supplied by publisher]

    Comin E, Catalan-Ramos A, Iglesias-Rodal M, Grau M, Del Val JL, Consola A, Amado E, Pons A, Mata-Cases M, Franzi A, Ciurana R, Frigola E, Cos X, Davins J, Verdu-Rotellar JM
  32. Evidence-Based Guidelines for the Pharmacological Management of Acute Methamphetamine-Related Disorders and Toxicity.

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    Pharmacopsychiatry. 2017 Mar 15;:

    Authors: Wodarz N, Krampe-Scheidler A, Christ M, Fleischmann H, Looser W, Schoett K, Vilsmeier F, Bothe L, Schaefer C, Gouzoulis-Mayfrank E

    PMID: 28297728 [PubMed - as supplied by publisher]

    Wodarz N, Krampe-Scheidler A, Christ M, Fleischmann H, Looser W, Schoett K, Vilsmeier F, Bothe L, Schaefer C, Gouzoulis-Mayfrank E
  33. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Standard Reporting and Evaluation Guidelines: Results of a National Institutes of Health Working Group.

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    JAMA Dermatol. 2017 Mar 15;:

    Authors: Maverakis E, Wang EA, Shinkai K, Mahasirimongkol S, Margolis DJ, Avigan M, Chung WH, Goldman J, La Grenade L, Pirmohamed M, Shear NH, Tassaeeyakul W, Hoetzenecker W, Klaewsongkram J, Rerkpattanapipat T, Manuyakorn W, Yasuda SU, Sharon VR, Sukhov A, Micheletti R, Struewing J, French LE, Cheng MY

    Abstract
    Importance: Toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS) are rare, acute, life-threatening dermatologic disorders involving the skin and mucous membranes. Research into these conditions is hampered by a lack of standardization of case reporting and data collection.
    Objective: To establish a standardized case report form to facilitate comparisons and maintain data quality based on an international panel of SJS/TEN experts who performed a Delphi consensus-building exercise.
    Evidence Review: The elements presented for committee scrutiny were adapted from previous case report forms and from PubMed literature searches of highly cited manuscripts pertaining to SJS/TEN. The expert opinions and experience of the members of the consensus group were included in the discussion.
    Findings: Overall, 21 out of 29 experts who were invited to participate in the online Delphi exercise agreed to participate. Surveys at each stage were administered via an online survery software tool. For the first 2 Delphi rounds, results were analyzed using the Interpercentile Range Adjusted for Symmetry method and statements that passed consensus formulated a new case report form. For the third Delphi round, the case report form was presented to the committee, who agreed that it was "appropriate and useful" for documenting cases of SJS/TEN, making it more reliable and valuable for future research endeavors.
    Conclusions and Relevance: With the consensus of international experts, a case report form for SJS/TEN has been created to help standardize the collection of patient information in future studies and the documentation of individual cases.

    PMID: 28296986 [PubMed - as supplied by publisher]

    Maverakis E, Wang EA, Shinkai K, Mahasirimongkol S, Margolis DJ, Avigan M, Chung WH, Goldman J, La Grenade L, Pirmohamed M, Shear NH, Tassaeeyakul W, Hoetzenecker W, Klaewsongkram J, Rerkpattanapipat T, Manuyakorn W, Yasuda SU, Sharon VR, Sukhov A, Micheletti R, Struewing J, French LE, Cheng MY
  34. Engineering Bimetallic Ag-Cu Nanoalloys for Highly Efficient Oxygen Reduction Catalysts: A Guideline for Designing Ag-Based Electrocatalysts with Activity Comparable to Pt/C-20.

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    Small. 2017 Mar 15;:

    Authors: Wu X, Chen F, Zhang N, Qaseem A, Johnston RL

    Abstract
    Development of highly active and stable Pt-free oxygen reduction reaction catalysts from earth-abundant elements remains a grand challenge for highly demanded metal-air batteries. Ag-based alloys have many advantages over platinum group catalysts due to their low cost, high stability, and acceptable oxygen reduction reaction (ORR) performance in alkaline solutions. Nevertheless, compared to commercial Pt/C-20%, their catalytic activity still cannot meet the demand of commercialization. In this study, a kind of catalysts screening strategy on Agx Cu100-x nanoalloys is reported, containing the surface modification method, studies of activity enhancement mechanism, and applied research on zinc-air batteries. The results exhibit that the role of selective dealloying (DE) or galvanic displacement (GD) is limited by the "parting limitation", and this "parting limitation" determines the surface topography, position of d-band center, and ORR performance of Agx Cu100-x alloys. The GD-Ag55 Cu45 and DE-Ag25 Cu75 catalysts alloys present excellent ORR performance that is comparable to Pt/C-20%. The relationship between electronic perturbation and specific activity demonstrates that positive shift of the d-band center (≈0.12 eV, relative to Ag) for GD-Ag55 Cu45 is beneficial for ORR, which is contrary to Pt-based alloys (negative shift, ≈0.1 eV). Meanwhile, extensive electrochemical and electronic structure characterization indicates that the high work function of GD-Ag55 Cu45 (4.8 eV) is the reason behind their excellent durability for zinc-air batteries.

    PMID: 28296197 [PubMed - as supplied by publisher]

    Wu X, Chen F, Zhang N, Qaseem A, Johnston RL
  35. Systematic review of non-pharmacological analgesic interventions for common needle-related procedure in newborn infants and development of evidence-based clinical guidelines.

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    Acta Paediatr. 2017 Mar 12;:

    Authors: Lago P, Garetti E, Bellieni CV, Merazzi D, Savant Levet P, Ancora G, Pirelli A, Pain Study Group of the Italian Society of Neonatology

    Abstract
    The aim of this literature review was to develop clinical guidelines for the prevention and control of needle-related pain in newborn infants. The guidelines were developed by the Italian Society of Neonatology, using the Grading of Recommendations, Assessment, Development and Evaluation approach, based on the assessment of 232 papers published between 1986 and 2015. The quality of the evidence was high or moderate for some behavioural and non-pharmacological interventions.
    CONCLUSION: There was sufficient evidence to strongly support the use of non-pharmacological interventions for common needle-related procedures in newborn infants. Combined interventions seemed to be more effective in relieving procedural pain. This article is protected by copyright. All rights reserved.

    PMID: 28295585 [PubMed - as supplied by publisher]

    Lago P, Garetti E, Bellieni CV, Merazzi D, Savant Levet P, Ancora G, Pirelli A, Pain Study Group of the Italian Society of Neonatology
  36. Using the National Cancer Data Base for quality evaluation to assess adherence to treatment guidelines for nonmetastatic inflammatory breast cancer.

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    Cancer. 2017 Mar 13;:

    Authors: Lin HY, Bedrosian I, Babiera GV, Shaitelman SF, Kuerer HM, Woodward WA, Ueno NT, Shen Y

    Abstract
    BACKGROUND: Guidelines for the treatment of nonmetastatic inflammatory breast cancer (IBC) using trimodality therapy (TT) (chemotherapy, surgery, and radiotherapy) have remained largely unchanged since 2000. However, many patients with nonmetastatic IBC do not receive TT. It is unknown how patient-level (PL) and facility-level (FL) factors contribute to TT use.
    METHODS: Using the National Cancer Data Base, patients with nonmetastatic IBC who underwent locoregional treatment from 2003 through 2011 were identified. The authors correlated PL factors, including demographic and tumor characteristics, with TT use. An observed-to-expected ratio for the number of patients treated with TT was calculated for each hospital by adjusting for significant PL factors. Hierarchical mixed effects models were used to assess the percentage of variation in TT use attributable to PL and FL factors, respectively.
    RESULTS: Of the 542 hospitals examined, 55 (10.1%) and 24 (4.4%), respectively, were identified as significantly low and high outliers for TT use (P<.05). The percentage of the total variance in the use of TT attributable to the facility (11%) was nearly triple the variance attributable to the measured PL factors (3.4%). The nomogram generated from multivariate logistic regression of PL factors only allows a facility to assess TT use given their PL data.
    CONCLUSIONS: FL factors rather than PL factors appear to contribute disproportionately to the underuse of TT in patients with nonmetastatic IBC. To improve treatment guideline adherence for patients with nonmetastatic IBC, it is critical to identify the specific FL factors associated with TT underuse. More organized FL intervention is required to train physicians and to build multidisciplinary teams. Cancer 2017. © 2017 American Cancer Society.

    PMID: 28295213 [PubMed - as supplied by publisher]

    Lin HY, Bedrosian I, Babiera GV, Shaitelman SF, Kuerer HM, Woodward WA, Ueno NT, Shen Y
  37. Clinical Outcomes of Bronchiolitis After Implementation of a General Ward High Flow Nasal Cannula Guideline.

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    Hosp Pediatr. 2017 Apr;7(4):197-203

    Authors: Riese J, Porter T, Fierce J, Riese A, Richardson T, Alverson BK

    Abstract
    OBJECTIVE: The goal of this study was to assess the association of the introduction of a ward's high-flow nasal cannula (HFNC) guideline with clinical outcomes of infants with bronchiolitis.
    METHODS: We conducted a retrospective, pre-post intervention study with an interrupted time series analysis of infants admitted with bronchiolitis between 2010 and 2014 at an urban, tertiary care children's hospital. Patients admitted in the 24 months before and after initiation of a guideline for HFNC use on the general wards were compared. The primary outcome was length of hospital stay. Secondary outcomes were PICU transfer rate and length of stay, intubation rate, and 30-day readmission, adjusted for season.
    RESULTS: A total of 1937 patients met inclusion criteria; 936 were admitted before and 1001 admitted after the introduction of HFNC use on the general wards. Comparing the 2 groups, the hospital-wide rate of HFNC use in bronchiolitis treatment increased after HFNC became available on the wards (23.9% vs 35.2%; P < .001). The ward's HFNC guideline was not associated with a change in preintervention trajectory of total hospital length of stay (P = .48), PICU length of stay (P = .06), or rate of PICU transfer (P = .97). There was also no difference in intubation rate or 30-day readmission between the 2 groups.
    CONCLUSIONS: Initiating a guideline for HFNC use on the general pediatric wards was associated with an increase in the use of the intervention with no significant change in total hospital length of stay, PICU length of stay and transfer rate, intubation rate, or 30-day readmission for patients with bronchiolitis.

    PMID: 28292850 [PubMed - in process]

    Riese J, Porter T, Fierce J, Riese A, Richardson T, Alverson BK
  38. Development of an Official Guideline for the Economic Evaluation of Drugs/Medical Devices in Japan.

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    Value Health. 2017 Mar;20(3):372-378

    Authors: Shiroiwa T, Fukuda T, Ikeda S, Takura T, Moriwaki K

    Abstract
    OBJECTIVES: In Japan, cost-effectiveness evaluation was implemented on a trial basis from fiscal year 2016. The results will be applied to the future repricing of drugs and medical devices. On the basis of a request from the Central Social Insurance Medical Council (Chuikyo), our research team drafted the official methodological guideline for trial implementation. Here, we report the process of developing and the contents of the official guideline for cost-effectiveness evaluation.
    METHODS: The guideline reflects discussions at the Chuikyo subcommittee (e.g., the role of quality-adjusted life-year) and incorporates our academic perspective. Team members generated research questions for each section of the guideline and discussions on these questions were carried out. A draft guideline was prepared and submitted to the Ministry of Health, Labour and Welfare (MHLW), and then to the subcommittee. The draft guideline was revised on the basis of the discussions at the subcommitte, if appropriate.
    RESULTS: Although the "public health care payer's perspective" is standard in this guideline, other perspectives can be applied as necessary depending on the objective of analysis. On the basis of the discussions at the subcommittee, quality-adjusted life-year will be used as the basic outcome. A discount rate of 2% per annum for costs and outcomes is recommended. The final guideline was officially approved by the Chuikyo general assembly in February 2016.
    CONCLUSIONS: This is the first officially approved guideline for the economic evaluation of drugs and medical devices in Japan. The guideline is expected to improve the quality and comparability of submitted cost-effectiveness data for decision making.

    PMID: 28292481 [PubMed - in process]

    Shiroiwa T, Fukuda T, Ikeda S, Takura T, Moriwaki K
  39. AAP Releases Guideline on Brief Resolved Unexplained Events (BRUEs) and Evaluation of Lower-Risk Infants.

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    Am Fam Physician. 2017 Mar 01;95(5):330-331

    Authors: Hauk L

    PMID: 28290638 [PubMed - in process]

    Hauk L
  40. The adaptation and implementation of guidelines for responsible media reporting on suicide in Slovenia.

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    Zdr Varst. 2017 Mar 01;56(1):31-38

    Authors: Roškar S, Tančič Grum A, Poštuvan V, Podlesek A, De Leo D

    Abstract
    INTRODUCTION: The existing literature provides evidence of the link between media reporting and suicide in terms of either preventive or provocative effects. Hence, working with media representatives on responsible reporting on suicide is of great importance. Until recently in Slovenia, there has been an obvious lack of communication between media representatives and suicidologists. The aims of the present study were twofold; firstly, to introduce the adaptation and dissemination of intervention on responsible media reporting, and secondly, to evaluate the effectiveness of the implemented intervention on suicide reporting.
    METHODS: We used a pre-post research design. Newspaper articles were retrieved over two 12-month periods: the baseline period and the follow-up period. In between, we had a year of implementation of our intervention program (launching and disseminating the Guidelines via workshops). Each retrieved article was rated qualitatively with respect to its adherence to the Guidelines.
    RESULTS: The comparison of baseline and follow-up periods revealed some significant differences. Reporting in the follow-up period was less sensationalistic, there was less reporting about specific cases of suicides and more about causes of suicide and pathways out of mental distress. Furthermore, in the follow-up period, there was a significant improvement related to headlines of media articles. Contact information about where to seek help was more often included in the articles.
    CONCLUSION: The findings are promising, but working with the media needs to be continuous and ongoing if sustainable results are to be achieved.

    PMID: 28289461 [PubMed - in process]

    Roškar S, Tančič Grum A, Poštuvan V, Podlesek A, De Leo D
  41. [S2k guideline Helicobacter pylori and gastroduodenal ulcer disease 2016 - Statement on stress ulcer prophylaxis and optimized therapy].

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    Z Gastroenterol. 2017 Mar;55(3):307-309

    Authors: Hoffmann JC, Prinz C, Labenz J, Miehlke S, Malfertheiner P, Fischbach W

    PMID: 28288502 [PubMed - in process]

    Hoffmann JC, Prinz C, Labenz J, Miehlke S, Malfertheiner P, Fischbach W
  42. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients with Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society.

    mehr Informationen auf PubMed

    Related Articles

    Heart Rhythm. 2017 Mar 09;:

    Authors: Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW

    PMID: 28286247 [PubMed - as supplied by publisher]

    Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
  43. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society.

    mehr Informationen auf PubMed

    Related Articles

    Heart Rhythm. 2017 Mar 09;:

    Authors: Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW

    PMID: 28286246 [PubMed - as supplied by publisher]

    Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
  44. Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients with Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

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    Heart Rhythm. 2017 Mar 09;:

    Authors: Varosy PD, Chen LY, Miller AL, Noseworthy PA, Slotwiner DJ, Thiruganasambandamoorthy V

    Abstract
    OBJECTIVE: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.
    METHODS: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest.
    RESULTS: Of 3,188 citations reviewed, 10 studies met the inclusion criteria for systematic review, including a total of 676 patients. These included 9 randomized trials and 1 observational study. Of the 10 studies, 4 addressed patients with carotid sinus hypersensitivity, and the remaining 6 addressed vasovagal syncope. Among the 6 open-label (unblinded) studies, we found that pacing was associated with a 70% reduction in recurrent syncope (relative risk [RR]: 0.30; 95% confidence interval [CI]: 0.15-0.60). When the 2 analyzable studies with double-blinded methodology were considered separately, there was no clear benefit (RR: 0.73; 95% CI: 0.25-2.1), but confidence intervals were wide. The strongest evidence was from the randomized, double-blinded ISSUE-3 (Third International Study on Syncope of Uncertain Etiology) trial, which demonstrated a benefit of pacing among patients with recurrent syncope and asystole documented by implantable loop recorder.
    CONCLUSIONS: There are limited data with substantive evidence of outcome ascertainment bias, and only 2 studies with a double-blinded study design have been conducted. The evidence does not support the use of pacing for reflex-mediated syncope beyond patients with recurrent vasovagal syncope and asystole documented by implantable loop recorder.

    PMID: 28286245 [PubMed - as supplied by publisher]

    Varosy PD, Chen LY, Miller AL, Noseworthy PA, Slotwiner DJ, Thiruganasambandamoorthy V
  45. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society.

    mehr Informationen auf PubMed

    Related Articles

    J Am Coll Cardiol. 2017 Mar 09;:

    Authors: Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW

    PMID: 28286222 [PubMed - as supplied by publisher]

    Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
  46. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society.

    mehr Informationen auf PubMed

    Related Articles

    J Am Coll Cardiol. 2017 Mar 09;:

    Authors: Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW

    PMID: 28286221 [PubMed - as supplied by publisher]

    Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
  47. Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

    mehr Informationen auf PubMed

    Related Articles

    J Am Coll Cardiol. 2017 Mar 03;:

    Authors: Varosy PD, Chen LY, Miller AL, Noseworthy PA, Slotwiner DJ, Thiruganasambandamoorthy V

    Abstract
    OBJECTIVE: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.
    METHODS: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest.
    RESULTS: Of 3,188 citations reviewed, 10 studies met the inclusion criteria for systematic review, including a total of 676 patients. These included 9 randomized trials and 1 observational study. Of the 10 studies, 4 addressed patients with carotid sinus hypersensitivity, and the remaining 6 addressed vasovagal syncope. Among the 6 open-label (unblinded) studies, we found that pacing was associated with a 70% reduction in recurrent syncope (relative risk [RR]: 0.30; 95% confidence interval [CI]: 0.15-0.60). When the 2 analyzable studies with double-blinded methodology were considered separately, there was no clear benefit (RR: 0.73; 95% CI: 0.25-2.1), but confidence intervals were wide. The strongest evidence was from the randomized, double-blinded ISSUE-3 (Third International Study on Syncope of Uncertain Etiology) trial, which demonstrated a benefit of pacing among patients with recurrent syncope and asystole documented by implantable loop recorder.
    CONCLUSIONS: There are limited data with substantive evidence of outcome ascertainment bias, and only 2 studies with a double-blinded study design have been conducted. The evidence does not support the use of pacing for reflex-mediated syncope beyond patients with recurrent vasovagal syncope and asystole documented by implantable loop recorder.

    PMID: 28286220 [PubMed - as supplied by publisher]

    Varosy PD, Chen LY, Miller AL, Noseworthy PA, Slotwiner DJ, Thiruganasambandamoorthy V
  48. International therapeutic guidelines for patients with HCV-related extrahepatic disorders. A multidisciplinary expert statement.

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    Autoimmun Rev. 2017 Mar 07;:

    Authors: Zignego AL, Ramos-Casals M, Ferri C, Saadoun D, Arcaini L, Roccatello D, Antonelli A, Desbois AC, Comarmond C, Gragnani L, Casato M, Lamprecht P, Mangia A, Tzioufas AG, Younossi ZM, Cacoub P, ISG-EHCV

    Abstract
    Hepatitis C virus (HCV) is both hepatotrophic and lymphotropic virus that causes liver as well extrahepatic manifestations including cryoglobulinemic vasculitis, the most frequent and studied condition, lymphoma, and neurologic, cardiovascular, endocrine-metabolic or renal diseases. HCV-extrahepatic manifestations (HCV-EHMs) may severely affect the overall prognosis, while viral eradication significantly reduces non-liver related deaths. Different clinical manifestations may coexist in the same patient. Due to the variety of HCV clinical manifestations, a multidisciplinary approach along with appropriate therapeutic strategies are required. In the era of interferon-free anti-HCV treatments, international recommendations for the therapeutic management of HCV-EHMs are needed. This implies the need to define the best criteria to use antivirals and/or other therapeutic approaches. The present recommendations, based on qualified expert experience and specific literature, will focus on etiological (antiviral) therapies and/or traditional pathogenetic treatments that still maintain their therapeutic utility.

    PMID: 28286108 [PubMed - as supplied by publisher]

    Zignego AL, Ramos-Casals M, Ferri C, Saadoun D, Arcaini L, Roccatello D, Antonelli A, Desbois AC, Comarmond C, Gragnani L, Casato M, Lamprecht P, Mangia A, Tzioufas AG, Younossi ZM, Cacoub P, ISG-EHCV
  49. Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group.

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    Actas Urol Esp. 2017 Mar 09;:

    Authors: Gómez-Veiga F, Rodríguez-Antolín A, Miñana B, Hernández C, Suárez JF, Fernández-Gómez JM, Unda M, Burgos J, Alcaraz A, Rodríguez P, Medina R, Castiñeiras J, Moreno C, Pedrosa E, Cózar JM, GESCAP

    Abstract
    OBJECTIVE: To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain.
    PATIENTS AND METHODS: Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D'Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests.
    RESULTS: Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients' age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n=521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT.
    CONCLUSIONS: Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319).

    PMID: 28285790 [PubMed - as supplied by publisher]

    Gómez-Veiga F, Rodríguez-Antolín A, Miñana B, Hernández C, Suárez JF, Fernández-Gómez JM, Unda M, Burgos J, Alcaraz A, Rodríguez P, Medina R, Castiñeiras J, Moreno C, Pedrosa E, Cózar JM, GESCAP
  50. [Use of the S3 guidelines for early detection of prostate cancer in urological practices].

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    Urologe A. 2017 Mar 09;:

    Authors: Tiedje D, Quer O, Breil B, Schrader AJ, Bothe C, Kruse K, Bögemann M, Donner-Banzhoff N, Semjonow A

    Abstract
    OBJECTIVES: The German S3 guideline on prostate cancer gives recommendations on early detection of prostate cancer. In this study we analyzed the adherence of urologists in private practice from the administrative district of Münster, Germany to this guideline.
    METHODS: Data were collected through a semistructured survey of 22 urologists based on the COREQ checklist (Consolidated criteria for reporting qualitative research) in four focus groups consisting of five or six urologists in private practice. We developed 23 questions relating to 12 recommendations of the paragraphs of the S3 guidelines dealing with early detection of prostate cancer and prostate biopsy. The recommendations of the guideline are subdivided in nine "strong", one "optional recommendation" and two "statements". The adherence to the guideline was investigated by using frequency and qualitative content analysis (Mayring) based on a mixed methods design.
    RESULTS: The urologists follow six of the nine "strong recommendations" of the guideline and deviate from three. Reasons for deviations from "strong recommendations" are the following: information about advantages and disadvantages of early detection for prostate cancer, recommendation of a prostate biopsy in case of PSA level ≥4 ng/ml, and indication for repeat biopsy.
    CONCLUSION: Most of the "strong recommendations" are followed by the interviewed urologists of the administrative district of Münster. Contextually relevant deviations from "strong recommendations" are justified, e. g., the only limited transferability of the PSA threshold of 4 ng/ml derived from population-based studies of asymptomatic men to men presenting in a urologist's office.

    PMID: 28280863 [PubMed - as supplied by publisher]

    Tiedje D, Quer O, Breil B, Schrader AJ, Bothe C, Kruse K, Bögemann M, Donner-Banzhoff N, Semjonow A
  51. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society.

    mehr Informationen auf PubMed

    Circulation. 2017 Mar 09;:

    Authors: Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW

    PMID: 28280232 [PubMed - as supplied by publisher]

    Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
  52. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society.

    mehr Informationen auf PubMed

    Circulation. 2017 Mar 09;:

    Authors: Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW

    PMID: 28280231 [PubMed - as supplied by publisher]

    Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW
  53. Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope: A Systematic Review for the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society.

    mehr Informationen auf PubMed

    Circulation. 2017 Mar 09;:

    Authors: Varosy PD, Chen LY, Miller AL, Noseworthy PA, Slotwiner DJ, Thiruganasambandamoorthy V

    PMID: 28280230 [PubMed - as supplied by publisher]

    Varosy PD, Chen LY, Miller AL, Noseworthy PA, Slotwiner DJ, Thiruganasambandamoorthy V
  54. Care following stillbirth in high-resource settings: Latest evidence, guidelines, and best practice points.

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    Semin Fetal Neonatal Med. 2017 Mar 06;:

    Authors: Bakhbakhi D, Burden C, Storey C, Siassakos D

    Abstract
    Third-trimester stillbirth affects approximately 2.6 million women worldwide each year. Although most stillbirths (98%) occur in low- and middle-income countries, most of the research on the impact of stillbirth and bereavement care has come from high-income countries. The impact of stillbirth ranges from stigma to disenfranchised grief, broken relationships, clinical depression, chronic pain, substance use, increased use of health services, employment difficulties, and debt. Appropriate bereavement care following a stillbirth is essential to minimise the negative socio-economic impact on parents and their families. This article presents the best practice points in stillbirth bereavement care, including taking an individualised and flexible approach. The latest published research, guidelines, and best practice points from high-income countries will be used and will highlight the gaps in the research which urgently need to be addressed. Research and investment in appropriate, respectful aftercare is needed to minimise the negative impact for parents.

    PMID: 28279640 [PubMed - as supplied by publisher]

    Bakhbakhi D, Burden C, Storey C, Siassakos D
  55. Understanding optimal approaches to patient and caregiver engagement in the development of cancer practice guidelines: a mixed methods study.

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    BMC Health Serv Res. 2017 Mar 09;17(1):186

    Authors: Brouwers MC, Vukmirovic M, Spithoff K, Makarski J

    Abstract
    BACKGROUND: Practice guidelines (PGs) can assist health care practitioners and patients to make decisions about health care options. A key component of high quality PGs is the consideration of patient values and preferences. A mixed methods study was conducted to understand optimal approaches to patient engagement in the development of cancer PGs.
    METHODS: Cancer patients, survivors, family members and caregivers were recruited from cancer clinics, follow-up clinics, community support programs, a provincial patient and family advisory committee, and a provincial cancer PG development program. Participants attended a workshop, completed a survey, or participated in a telephone interview, to provide information about PG awareness, attitudes, information needs, training, engagement approaches and barriers and facilitators.
    RESULTS: Forty-one participants (12 workshop attendees, 21 survey respondents and 8 interviewees) provided data. For those with no PG development experience, fewer than half were previously aware of PGs but perceived several benefits to the inclusion of this perspective. Common barriers to participation across the groups were time commitment, duration of the PG development process, and financial costs. Positive beliefs about the contributions that could be made and practical considerations (e.g., orientation and training, defined roles and expectations) were identified as key features in the successful integration of patients into the PG development process. There was no single model of engagement favored over another.
    CONCLUSIONS: Study results align with similar studies in other contexts and with international patient engagement efforts. Findings are being used to test new patient engagement models in a programmatic PG development initiative in Ontario, Canada.

    PMID: 28279216 [PubMed - in process]

    Brouwers MC, Vukmirovic M, Spithoff K, Makarski J
  56. Factors associated with nursing students' adherence to venous blood collection practice guidelines - A cross sectional study.

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    Nurse Educ Pract. 2017 Mar;23:92-98

    Authors: Nilsson K, Brulin C, Grankvist K, Juthberg C

    Abstract
    Venous blood specimen collection is a common procedure that nursing students perform during pre-registration courses, and training for such collections takes place on campus as well as at clinical placements. However, levels of adherence to practice guidelines are still suboptimal among both nursing students and healthcare staff. We aimed to explore nursing students' adherence to the Swedish national venous blood specimen collection practice guidelines regarding patient identification and test request management and how this adherence is related to clinical experience, capability beliefs, research use, and the perceived social climate in clinical contexts. A survey with a cross-sectional design was conducted among 305 nursing students at a medium-sized university in Sweden. Descriptive statistics and logistic regression were used for data analysis. The survey showed that 82% of the students adhered to patient identification guideline practices and 80% to test request management practices. Factors associated with correct patient identification procedures were semester and frequency of research use. Factors associated with correct test request management were previous healthcare work experience, semester, and capability beliefs regarding academic abilities and evidence-based practice. We conclude that there is a need to develop educational tools to train students in research use and evidence-based practice in order to enhance guideline practice adherence and improve patient safety.

    PMID: 28278444 [PubMed - indexed for MEDLINE]

    Nilsson K, Brulin C, Grankvist K, Juthberg C
  57. Impact of a National Guideline on Antibiotic Selection for Hospitalized Pneumonia.

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    Pediatrics. 2017 Mar 08;:

    Authors: Williams DJ, Hall M, Gerber JS, Neuman MI, Hersh AL, Brogan TV, Parikh K, Mahant S, Blaschke AJ, Shah SS, Grijalva CG, Pediatric Research in Inpatient Settings Network

    Abstract
    BACKGROUND: We evaluated the impact of the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America pneumonia guideline and hospital-level implementation efforts on antibiotic prescribing for children hospitalized with pneumonia.
    METHODS: We assessed inpatient antibiotic prescribing for pneumonia at 28 children's hospitals between August 2009 and March 2015. Each hospital was also surveyed regarding local implementation efforts targeting antibiotic prescribing and organizational readiness to adopt guideline recommendations. To estimate guideline impact, we used segmented linear regression to compare the proportion of children receiving penicillins in March 2015 with the expected proportion at this same time point had the guideline not been published based on a projection of a preguideline trend. A similar approach was used to estimate the short-term (6-month) impact of local implementation efforts. The correlations between organizational readiness and the impact of the guideline were estimated by using Pearson's correlation coefficient.
    RESULTS: Before guideline publication, penicillin prescribing was rare (<10%). After publication, an absolute increase in penicillin use was observed (27.6% [95% confidence interval: 23.7%-31.5%]) by March 2015. Among hospitals with local implementation efforts (n = 20, 71%), the median increase was 29.5% (interquartile range: 19.6%-39.1%) compared with 20.1% (interquartile rage: 9.5%-44.5%) among hospitals without such activities (P = .51). The independent, short-term impact of local implementation efforts was similar in magnitude to that of the national guideline. Organizational readiness was not correlated with prescribing changes.
    CONCLUSIONS: The publication of the Pediatric Infectious Diseases Society/Infectious Diseases Society of America guideline was associated with sustained increases in the use of penicillins for children hospitalized with pneumonia. Local implementation efforts may have enhanced guideline adoption and appeared more relevant than hospitals' organizational readiness to change.

    PMID: 28275204 [PubMed - as supplied by publisher]

    Williams DJ, Hall M, Gerber JS, Neuman MI, Hersh AL, Brogan TV, Parikh K, Mahant S, Blaschke AJ, Shah SS, Grijalva CG, Pediatric Research in Inpatient Settings Network
  58. Critical Evaluation of the Quality and Recommendations of Clinical Practice Guidelines for Nasopharyngeal Carcinoma.

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    J Natl Compr Canc Netw. 2017 Mar;15(3):336-344

    Authors: Chen YP, Wang YQ, Li WF, Chen L, Xu C, Lu TX, Lin AH, Yao JJ, Li YC, Sun Y, Mao YP, Ma J

    Abstract
    Background: Given the distinct biological characteristics and regional distribution of nasopharyngeal carcinoma (NPC) compared with other head and neck cancers, and uncertainties regarding therapeutic strategies, physicians require high-quality clinical practice guidelines (CPGs) to provide transparent recommendations for NPC treatment. This study aimed to critically appraise the quality of NPC CPGs and assess the consistency of their recommendations. Methods: We identified CPGs that provided recommendations on the diagnosis and management of NPC published up to December 2015. Four investigators independently appraised CPG quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Key recommendations by CPGs were also evaluated. Results: A total of 7 CPGs were eligible for this study: 5 produced by professional organizations or governmental agencies and 2 were developed based on expert consensus. Of the 6 AGREE II domains, the applicability domain scored consistently low across CPGs (range, 13.5%-30.2%); no CPG achieved a score of >50% in all 6 domains. The scope and purpose domain (≥73.6% for 4 CPGs) and editorial independence domain (≥75.0% for 6 CPGs) scored highest. Of the 23 AGREE II items, 9 scored less than half of the points available in all 7 CPGs. The recommendations by CPGs were consistent in general; heterogeneity mainly existed among recommended therapeutic strategies. Conclusions: Variation exists in NPC CPG development processes and recommendations. Increased efforts are required to make comprehensive resources available to guide healthcare providers and enhance delivery of high-quality, evidence-based care for NPC. International collaboration is necessary to enable the development of high-quality and regionally relevant CPGs for NPC.

    PMID: 28275034 [PubMed - in process]

    Chen YP, Wang YQ, Li WF, Chen L, Xu C, Lu TX, Lin AH, Yao JJ, Li YC, Sun Y, Mao YP, Ma J
  59. The Association between Dietary Quality and Dietary Guideline Adherence with Mental Health Outcomes in Adults: A Cross-Sectional Analysis.

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    Nutrients. 2017 Mar 05;9(3):

    Authors: Meegan AP, Perry IJ, Phillips CM

    Abstract
    The prevalence of adverse mental health outcomes in adults is increasing. Although beneficial effects of selected micronutrients and foods on mental health have been reported, they do not reflect the impact of the habitual diet on mental health. Therefore, our objective is to examine potential associations between dietary quality, dietary composition and compliance with food pyramid recommendations with depressive symptoms, anxiety and well-being (assessed using CES-D, HADS-A and WHO-5 screening tools) in a cross-sectional sample of 2047 middle-aged adults. Diet was assessed using a self-completed FFQ. Chi-square tests, t-tests and logistic regression analyses were used to investigate the associations between dietary components and mental health outcomes. Dietary quality, but not dietary composition or guideline adherence, was associated with well-being. Those with high dietary quality were more likely to report well-being (OR =1.67, 95% CI 1.15-2.44, p = 0.007) relative to those with low dietary quality. This remained significant among females (OR = 1.92, (95% CI 1.14-3.23, p = 0.014) and non-obese individuals (OR = 2.03, 95% CI 1.28-3.20, p = 0.003). No associations between any dietary measures with anxiety or depressive symptoms were observed. These novel results highlight the importance of dietary quality in maintaining optimal psychological well-being. Better understanding of the relationship between dietary quality and mental health may provide insight into potential therapeutic or intervention strategies to improve mental health and well-being.

    PMID: 28273871 [PubMed - in process]

    Meegan AP, Perry IJ, Phillips CM
  60. Erratum to: Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial.

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    Intensive Care Med. 2017 Mar 07;:

    Authors: Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A

    PMID: 28271319 [PubMed - as supplied by publisher]

    Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A
  61. Assessing the Quality of Mobile Exercise Apps Based on the American College of Sports Medicine Guidelines: A Reliable and Valid Scoring Instrument.

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    J Med Internet Res. 2017 Mar 07;19(3):e67

    Authors: Guo Y, Bian J, Leavitt T, Vincent HK, Vander Zalm L, Teurlings TL, Smith MD, Modave F

    Abstract
    BACKGROUND: Regular physical activity can not only help with weight management, but also lower cardiovascular risks, cancer rates, and chronic disease burden. Yet, only approximately 20% of Americans currently meet the physical activity guidelines recommended by the US Department of Health and Human Services. With the rapid development of mobile technologies, mobile apps have the potential to improve participation rates in exercise programs, particularly if they are evidence-based and are of sufficient content quality.
    OBJECTIVE: The goal of this study was to develop and test an instrument, which was designed to score the content quality of exercise program apps with respect to the exercise guidelines set forth by the American College of Sports Medicine (ACSM).
    METHODS: We conducted two focus groups (N=14) to elicit input for developing a preliminary 27-item scoring instruments based on the ACSM exercise prescription guidelines. Three reviewers who were no sports medicine experts independently scored 28 exercise program apps using the instrument. Inter- and intra-rater reliability was assessed among the 3 reviewers. An expert reviewer, a Fellow of the ACSM, also scored the 28 apps to create criterion scores. Criterion validity was assessed by comparing nonexpert reviewers' scores to the criterion scores.
    RESULTS: Overall, inter- and intra-rater reliability was high with most coefficients being greater than .7. Inter-rater reliability coefficients ranged from .59 to .99, and intra-rater reliability coefficients ranged from .47 to 1.00. All reliability coefficients were statistically significant. Criterion validity was found to be excellent, with the weighted kappa statistics ranging from .67 to .99, indicating a substantial agreement between the scores of expert and nonexpert reviewers. Finally, all apps scored poorly against the ACSM exercise prescription guidelines. None of the apps received a score greater than 35, out of a possible maximal score of 70.
    CONCLUSIONS: We have developed and presented valid and reliable scoring instruments for exercise program apps. Our instrument may be useful for consumers and health care providers who are looking for apps that provide safe, progressive general exercise programs for health and fitness.

    PMID: 28270378 [PubMed - in process]

    Guo Y, Bian J, Leavitt T, Vincent HK, Vander Zalm L, Teurlings TL, Smith MD, Modave F
  62. Changes to infant feeding guidelines: Relevance to dermatologists.

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    Australas J Dermatol. 2017 Mar 07;:

    Authors: Wong CC, Allen KJ, Orchard D

    Abstract
    The newly revised Australian Infant Feeding Guidelines recommends that all infants, including those at high risk of allergy, be introduced foods traditionally considered allergenic (such as peanut butter, dairy, wheat and egg) within the first year of life. High-risk infants are those with early onset eczema (<3-months old) or with moderate to severe eczema not responding to treatment (<6-months old). Eczema can also represent a symptom of allergy presentation and the recommended introduction of some foods in this group may lead to allergic reactions at home. Although there have been no reported deaths from gradual food introduction to infants at home and cohort studies have only reported mild to moderate reactions, there is anecdotal evidence that more severe reactions can occur rarely. Allergic reactions, even if they are not life-threatening, can be a terrifying experience for parents. Dermatologists play an important role when dealing with high-risk infants in promoting the message of early allergenic food introduction yet also instigating appropriate allergy testing when necessary. This short review aims to provide an update to Australasian dermatologists on the newly revised Australian Infant Feeding Guidelines and provide a food allergy screening pathway for high-risk infants prior to commencement of allergenic foods.

    PMID: 28266703 [PubMed - as supplied by publisher]

    Wong CC, Allen KJ, Orchard D
  63. [Guidelines for the treatment of hypertension: remarkable transatlantic consensus].

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    MMW Fortschr Med. 2017 Mar;159(4):65-67

    Authors: Holzgreve H

    PMID: 28265911 [PubMed - in process]

    Holzgreve H
  64. [Health economic evaluation reporting guideline and application status].

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    Zhonghua Yu Fang Yi Xue Za Zhi. 2017 Mar 06;51(3):276-280

    Authors: Xiao J, Sun JF, Wang QQ, Qi X, Yao HY

    Abstract
    Using the guidelines of health economic evaluation reporting is conducive to regulating the contents of this reporting, improving the quality of studies into health economics evaluation. This article summarized the history of the guidelines and specified the instrument used to study " Quality of Health Economic Studies (QHES)" and the checklist about Consolidated Health Economics Evaluation Reporting Standards (CHEERS)-the two specific evaluation contents in this guideline, the article also introduced its present application status of the guideline and its pros and cons. The checklist of CHEERS emphasized the evaluation of this report, while QHES instrument focused on quantitative evaluation on the quality of economic studies. Despite different emphasis, the two guides are actually mutually complemented.

    PMID: 28260345 [PubMed - in process]

    Xiao J, Sun JF, Wang QQ, Qi X, Yao HY
  65. Is there consensus across international evidence-based guidelines for the management of bipolar disorder?

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    Acta Psychiatr Scand. 2017 Mar 05;:

    Authors: Parker GB, Graham RK, Tavella G

    Abstract
    OBJECTIVE: To examine the level of agreement across professionally auspiced evidence-based guidelines for managing the bipolar disorders.
    METHODS: A literature search in PubMed, the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews and PsycInfo was undertaken using the search terms 'bipolar disorder' and 'guidelines', generating 11 evidence-based guidelines published by professional organisations over the 2002-2015 period. Each guideline was reviewed by two independent reviewers and key themes extracted via qualitative analyses.
    RESULTS: There was agreement on issues such as the first-line treatment of mania where mood-stabilising and/or an antipsychotic medication together with tapering or ceasing antidepressant medications was most commonly recommended. Differences included the extent to which (i) the different bipolar disorders were defined or not, (ii) there were separate recommendations for bipolar I and bipolar II disorders vs. non-differentiating general bipolar management strategies, (iii) 'general' vs. severity-based recommendations were made, and (iv) narrow vs. broad sets of candidate medications were nominated, while there was variable consideration of treatments such as electroconvulsive therapy (ECT).
    CONCLUSIONS: While there was some consistency across guidelines on key recommendations, there was also substantial inconsistencies, limiting the generation of any 'meta-consensus' model for managing the bipolar disorders.

    PMID: 28260229 [PubMed - as supplied by publisher]

    Parker GB, Graham RK, Tavella G
  66. [New worldwide guidelines for treatment of inguinal hernia : The most important recommendations from HerniaSurge].

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    Chirurg. 2017 Mar 03;:

    Authors: Weyhe D

    Abstract
    SURGICAL TECHNIQUES: In the HerniaSurge guidelines the highest evidence is found with respect to recommendations for mesh-based surgery techniques. This includes Lichtenstein as well as the minimally invasive TEP/TAPP surgery. For discreet symptomatic or asymptomatic inguinal hernia, watchful waiting is an option if the state of health and social situation are taken into account; however, femoral hernia should be treated promptly with a mesh technique, with laparoendoscopic techniques being the more favored option. Recurrence rates in open repair are lowest for Shouldice, thus representing an acceptable alternative in certain indications.
    MESH SELECTION: Potential complications of mesh implants should be discussed with the patient. The area density of the mesh is not a suitable parameter for mesh selection. Large pore (>1-1.5 mm) monofilament implants offer the best integration potential and should exhibit a minimum tearing force of approximately 16 Nm(2). Traumatic mesh fixation is only recommended for large medial hernias (M3-EHS). Especially not recommended are plug and patch, PHS systems and other three-dimensional devices, since the use of these devices involves the anterior as well as the posterior planar layers, which makes using complementary techniques in cases of recurrence more complicated.
    PERIOPERATIVE AND POSTOPERATIVE ASPECTS: Perioperative antibiotic prophylaxis in open repair is only recommended for patients with higher risk of infection. For laparoendoscopic surgery antibiotic prophylaxis if at all should only be used with caution. Careful preparation reduces chronic groin and testicle pain. A resection of nerves may be performed if the nerves interfere with the mesh. A fast return to daily activities within 3-5 days is safe.
    QUALITY CONTROL: Registries for documentation of patient data should be implemented to improve quality control and for furthering therapy options. Implemention of the guidelines will be supported by HerniaSurge.

    PMID: 28258383 [PubMed - as supplied by publisher]

    Weyhe D
  67. Clinical Specialization and Adherence to Evidence-Based Practice Guidelines for Low Back Pain Management: A Survey of United States Physical Therapists.

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    J Orthop Sports Phys Ther. 2017 Mar 03;:1-44

    Authors: Ladeira CE, Cheng MS, da Silva RA

    Abstract
    Study Design Electronic cross-sectional survey. Background The American Physical Therapy Association (APTA) EBP guideline for low back pain (LBP) elaborated on strategies to manage non-specific LBP in routine physical therapy practice. This guideline described LBP associated with mobility deficit, leg pain and a directional preference, coordination impairment (lumbar instability), and fear avoidance behavior (FAB). Objectives To assess American physical therapists' (PTs) adherence to the Clinical Practice Guidelines (CPG) for LBP of the Orthopaedic Section of the APTA, and to compare adherence among PTs with different qualifications. Methods The investigators contacted 1,861 members of the Orthopaedic Section of the APTA and 1,000 members of the American Academy of Orthopaedic Manual Physical Therapy (AAOMPT). Participants made treatment choices for four clinical vignettes: LBP with mobility deficit, coordination impairment, leg pain (directional preference), or FAB. The investigator used logistic regression analyses to compare guideline adherence among PTs with the following qualifications: orthopaedic clinical specialists (PTOs), Fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and PTs without clinical specialization but with a musculoskeletal interest (PTMSs). Results A total of 410 PTs completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs, and 84 PTMSs). Adherence to the APTA's CPG was highest for LBP associated with leg pain and a directional preference (72.2%), followed by LBP with mobility deficit (57.1%), then LBP with coordination impairment (46.1%) and with FAB (29.5%). PTFOs adhered better to the CPG for LBP than PTMSs for all four patient vignettes. PTOs adhered better to the CPG for LBP with mobility deficit and for LBP with FAB than PTMSs. Limitations There design has potential for non-response and self-selection bias. Conclusions PTFOs and PTOs adhered better to the CPG than PTMSs. Based on our preliminary results, further education on the CPG for LBP management is needed, particularly for managing LBP with coordination impairment and with FAB. J Orthop Sports Phys Ther, Epub 3 Mar 2017. doi:10.2519/jospt.2017.6561.

    PMID: 28257618 [PubMed - as supplied by publisher]

    Ladeira CE, Cheng MS, da Silva RA
  68. Evaluation of guidelines for injured children at high risk for VTE: A prospective observational study.

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    J Trauma Acute Care Surg. 2017 Mar 02;:

    Authors: Landisch RM, Hanson SJ, Cassidy LD, Braun K, Punzalan RC, Gourlay DM

    Abstract
    BACKGROUND: Pharmacologic prophylaxis for venous thromboembolism (VTE) is a widely accepted practice in adult trauma patients to prevent associated morbidity and mortality. However, VTE prophylaxis has not been standardized in injured pediatric patients. Our institution identified factors potentially associated with a high risk of VTE in critically injured children that led to prospective implementation of VTE prophylaxis guidelines. We hypothesize the guidelines are accurate in predicting children at risk for VTE.
    METHODS: Data were prospectively collected on injured children from 8/2010-8/2015. Pharmacologic prophylaxis was indicated for patients identified by the guidelines as high risk for VTE. Prophylaxis was deferred and a screening ultrasound (US) performed if the high risk VTE patients were also at high risk for bleeding. To assess the accuracy of predicting confirmed cases of VTE, stepwise logistic regression analysis was used to measure the association of individual risk factors with VTE controlling for age (≥13 years). A receiver operating characteristic (ROC) curve measured the accuracy of the final model to predict a VTE.
    RESULTS: Of 4061 trauma patients, 588 were admitted to the ICU, with the guidelines identifying 199 as high risk for VTE. VTE occurred in 3.9% (23/588) of the ICU population and 10% (20/199) of the high risk group. The median age of VTE patients in the ICU was 9.7 years. Statistically significant predictors (p<0.05) of VTE in the multivariate model included presence of a central venous catheter (OR=5.2), inotropes (OR=7.7), immobilization (OR=5.5) and a Glasgow Coma Scale (GCS) < 9 (OR=1.3). The area under ROC curve of this model was 0.92, demonstrating its excellent predictive ability.
    CONCLUSIONS: Specific clinical factors in critically injured children are associated with a high risk for VTE. Incorporating these risk factors in VTE prophylaxis guidelines facilitates more accurate risk stratification and may allow for improved VTE prevention in pediatric trauma.
    LEVEL OF EVIDENCE: Prognostic study, level II.

    PMID: 28257391 [PubMed - as supplied by publisher]

    Landisch RM, Hanson SJ, Cassidy LD, Braun K, Punzalan RC, Gourlay DM
  69. Evidence-Based Tightrope Walking: The 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum.

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    Thyroid. 2017 Mar;27(3):309-311

    Authors: Korevaar TI

    PMID: 28257275 [PubMed - in process]

    Korevaar TI
  70. Circulating tumor markers: a guide to their appropriate clinical use | Comparative summary of recommendations from clinical practice guidelines (PART 2).

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    Int J Biol Markers. 2017 Mar 02;32(1):e1-e52

    Authors: Gion M, Trevisiol C, Rutjes AW, Rainato G, Fabricio AS

    PMID: 28255982 [PubMed - as supplied by publisher]

    Gion M, Trevisiol C, Rutjes AW, Rainato G, Fabricio AS
  71. Objectively Measured Adherence to Physical Activity Guidelines After Acute Coronary Syndrome.

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    J Am Coll Cardiol. 2017 Mar 07;69(9):1205-1207

    Authors: Kronish IM, Diaz KM, Goldsmith J, Moise N, Schwartz JE

    PMID: 28254185 [PubMed - in process]

    Kronish IM, Diaz KM, Goldsmith J, Moise N, Schwartz JE
  72. Policy at play: The implementation of Healthy Eating and Active Living Guidelines in municipal child care settings.

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    Can J Public Health. 2017 Mar 01;107(6):e556-e561

    Authors: McKay K, Nigro S

    Abstract
    BACKGROUND: In 2012, Ottawa Public Health (OPH) partnered with the City of Ottawa Municipal Child Care (MCC) Services to develop Healthy Eating and Active Living (HEAL) Guidelines.
    SETTING: The Guidelines aim to promote consistent standards of practice in child care settings related to healthy environments and food, physical activity, physical literacy, decreased sedentary behaviours, and positive role modeling by staff. The Guidelines targeted 498 children aged 18 months to 5 years, attending MCC centres. Resources and training were provided to 10 supervisors, 63 child care educators and 9 cooks.
    INTERVENTION: Components of the Guidelines were piloted in 5 MCC sites prior to being launched in 10 MCC sites across Ottawa, Ontario. Two project Advisory Groups supported the development of the Guidelines. Staff training, resources, recipes and menus were provided. An evaluation was conducted and has informed the Guidelines' subsequent community implementation. In 2015, accompanying web-based resources and e-modules were developed.
    OUTCOMES: The evaluation demonstrated environmental and programming changes. Parent satisfaction was high and preliminary findings showed no real changes in food costs. Following implementation, the cooks reported high compliance to the 6-week menu plans provided, and the number of sites offering 120 minutes or more of daily physical activity increased.
    IMPLICATIONS: Through novel intersectoral partnerships, OPH was able to implement and evaluate HEAL Guidelines in tandem. The interdisciplinary project Advisory Groups, training of cooks, and engagement of the Ontario Coaches Association were all innovative elements of this project and may influence future public health activity in this area.

    PMID: 28252375 [PubMed - in process]

    McKay K, Nigro S
  73. Meeting patient needs trumps adherence. A cross-sectional study of adherence and adaptations when national guidelines are used in practice.

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    J Eval Clin Pract. 2017 Mar 02;:

    Authors: Kakeeto M, Lundmark R, Hasson H, von Thiele Schwarz U

    Abstract
    RATIONALE, AIMS AND OBJECTIVES: In the evidence-to-practice pathway, guidelines are developed to provide a practical summary of evidence and stimulate change. However, when guidelines are used in practice, adherence to the recommendations in guidelines is limited, and adaptations are common. Thus, we need more detailed knowledge about adherence and adaptations when guidelines are used in practice to understand the end of the evidence-to-practice pathway. Subsequently, the aim is to examine adherence to and adaptations of recommendations in the Swedish National Guidelines for Methods of Preventing Disease.
    MATERIAL AND METHODS: A questionnaire was sent to healthcare professionals and managers in Stockholm between January and March 2014. Adherence to the recommendations was compared between practice settings, and the frequency of different adaptations and reasons for adaptations was analysed.
    RESULTS: Partial adherence to the guidelines was found. The adherence was significantly greater within primary care than at the hospitals (P < .001). Modifications formed the most common category of adaptations (55%) and included mainly prioritization of specific patient groups and increased patient customization. The most common reason for adaptations (25%) was to meet the patients' specific needs and capabilities.
    CONCLUSIONS: This study provides insight into adherence and adaptation when guidelines are used in practice. Work with lifestyle habits was partially done in accordance with the guidelines. Lack of time and lack of resources were not the most common reasons for adaptations. Rather, the findings suggest that when patient needs and capabilities contrast with guideline recommendations, patient needs trump adherence to guidelines.

    PMID: 28251758 [PubMed - as supplied by publisher]

    Kakeeto M, Lundmark R, Hasson H, von Thiele Schwarz U
  74. Editorial: Appropriate Use? Guidelines on Arthroscopic Surgery for Degenerative Meniscus Tears Need Updating.

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    Clin Orthop Relat Res. 2017 Mar 01;:

    Authors: Leopold SS

    PMID: 28251473 [PubMed - as supplied by publisher]

    Leopold SS
  75. Younger Age and Health Beliefs Associated with Being Overdue for Pap Testing among Utah Latinas who were Non-Adherent to Cancer Screening Guidelines.

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    J Immigr Minor Health. 2017 Mar 01;:

    Authors: Lai D, Bodson J, Warner EL, Ayres S, Mooney R, Kepka D

    Abstract
    Factors associated with being overdue for Papanicoloau (Pap) testing in a Latina community were examined. Female participants aged ≥ 21 years, who were overdue for one or more cancer screenings (N = 206), were purposively recruited. Descriptive statistics, Fisher's Exact Tests for count data, and multivariable logistic regressions were conducted. Participants overdue for cancer screening, aged 38-47 years demonstrated lower odds of being overdue for Pap testing compared with those 21-37 years old (OR = 0.11, 95% CI = 0.01-0.49, p = 0.01). Lower perceived susceptibility to cervical cancer (OR = 3.21, p = 0.02), and poorer perceived health (OR = 3.74, p < 0.01) was associated with being overdue for Pap testing. Cost/lack of insurance was the most common barrier reported among those overdue for Pap testing. Among an underserved population of Latinas, cost or a lack of health insurance persist as barriers to Pap testing. Evaluation of systematic barriers to accessing Pap testing for lower-income, uninsured individuals is recommended.

    PMID: 28251421 [PubMed - as supplied by publisher]

    Lai D, Bodson J, Warner EL, Ayres S, Mooney R, Kepka D
  76. Quality assurance guidelines for superficial hyperthermia clinical trials : II. Technical requirements for heating devices.

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    Strahlenther Onkol. 2017 Mar 01;:

    Authors: Dobšíček Trefná H, Crezee J, Schmidt M, Marder D, Lamprecht U, Ehmann M, Nadobny J, Hartmann J, Lomax N, Abdel-Rahman S, Curto S, Bakker A, Hurwitz MD, Diederich CJ, Stauffer PR, Van Rhoon GC

    Abstract
    Quality assurance (QA) guidelines are essential to provide uniform execution of clinical trials with uniform quality hyperthermia treatments. This document outlines the requirements for appropriate QA of all current superficial heating equipment including electromagnetic (radiative and capacitive), ultrasound, and infrared heating techniques. Detailed instructions are provided how to characterize and document the performance of these hyperthermia applicators in order to apply reproducible hyperthermia treatments of uniform high quality. Earlier documents used specific absorption rate (SAR) to define and characterize applicator performance. In these QA guidelines, temperature rise is the leading parameter for characterization of applicator performance. The intention of this approach is that characterization can be achieved with affordable equipment and easy-to-implement procedures. These characteristics are essential to establish for each individual applicator the specific maximum size and depth of tumors that can be heated adequately. The guidelines in this document are supplemented with a second set of guidelines focusing on the clinical application. Both sets of guidelines were developed by the European Society for Hyperthermic Oncology (ESHO) Technical Committee with participation of senior Society of Thermal Medicine (STM) members and members of the Atzelsberg Circle.

    PMID: 28251250 [PubMed - as supplied by publisher]

    Dobšíček Trefná H, Crezee J, Schmidt M, Marder D, Lamprecht U, Ehmann M, Nadobny J, Hartmann J, Lomax N, Abdel-Rahman S, Curto S, Bakker A, Hurwitz MD, Diederich CJ, Stauffer PR, Van Rhoon GC
  77. Health Risk Assessment of Dietary Cadmium Intake: Do Current Guidelines Indicate How Much is Safe?

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    Environ Health Perspect. 2017 03;125(3):284-288

    Authors: Satarug S, Vesey DA, Gobe GC

    Abstract
    BACKGROUND: Cadmium (Cd), a food-chain contaminant, is a significant health hazard. The kidney is one of the primary sites of injury after chronic Cd exposure. Kidney-based risk assessment establishes the urinary Cd threshold at 5.24 μg/g creatinine, and tolerable dietary intake of Cd at 62 μg/day per 70-kg person. However, cohort studies show that dietary Cd intake below a threshold limit and that tolerable levels may increase the risk of death from cancer, cardiovascular disease, and Alzheimer's disease.
    OBJECTIVE: We evaluated if the current tolerable dietary Cd intake guideline and urinary Cd threshold limit provide sufficient health protection.
    DISCUSSION: Staple foods constitute 40-60% of total dietary Cd intake by average consumers. Diets high in shellfish, crustaceans, mollusks, spinach, and offal add to dietary Cd sources. Modeling studies predict the current tolerable dietary intake corresponding to urinary Cd of 0.70-1.85 μg/g creatinine in men and 0.95-3.07 μg/g creatinine in women. Urinary Cd levels of < 1 μg/g creatinine were associated with progressive kidney dysfunction and peripheral vascular disease. A urinary Cd of 0.37 μg/g creatinine was associated with breast cancer, whereas dietary Cd of 16-31.5 μg/day was associated with 25-94% increase in risk of estrogen receptor-positive breast cancer.
    CONCLUSION: Modeling shows that dietary intake levels for Cd exceed the levels associated with kidney damage and many other adverse outcomes. Thus, the threshold level of urinary Cd should be re-evaluated. A more restrictive dietary intake guideline would afford enhanced health protection from this pervasive toxic metal. Citation: Satarug S, Vesey DA, Gobe GC. 2017. Health risk assessment of dietary cadmium intake: do current guidelines indicate how much is safe? Environ Health Perspect 125:284-288; http://dx.doi.org/10.1289/EHP108.

    PMID: 28248635 [PubMed - in process]

    Satarug S, Vesey DA, Gobe GC
  78. Guideline Implementation: Energy-Generating Devices, Part 1-Electrosurgery.

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    AORN J. 2017 Mar;105(3):300-310

    Authors: Eder SP

    Abstract
    Energy-generating devices are standard equipment in the surgical suite, with electrosurgical units being the most common type of electrical device used in the OR. Prevention of injuries to patients and personnel related to the use of energy-generating devices is a key component of the perioperative nurse's role. The AORN "Guideline for safe use of energy-generating devices" provides guidance on the use and maintenance of devices that deliver energy in the forms of radiofrequency waves, ultrasound waves, or lasers. This article focuses on key points of the guideline, which address precautions specific to electrosurgical units, patients with implanted electronic devices, and minimally invasive surgery, and documentation of the use of energy-generating devices. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

    PMID: 28241952 [PubMed - in process]

    Eder SP
  79. Appropriateness of Plasma Transfusion: A College of American Pathologists Q-Probes Study of Guidelines, Waste, and Serious Adverse Events.

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    Arch Pathol Lab Med. 2017 Mar;141(3):396-401

    Authors: Alcorn K, Ramsey G, Souers R, Lehman CM

    Abstract
    CONTEXT: - Plasma transfusion guidelines support patient care and safety, management of product wastage, and compliance; yet, there is little information across multiple institutions about use of and adherence to plasma transfusion guidelines.
    OBJECTIVE: - To survey multiple institutions regarding their plasma transfusion guidelines and compliance, plasma wastage rates, and incidence of transfusion reactions associated with plasma transfusion.
    DESIGN: - The College of American Pathologists Q-Probes model was used to collect data from 89 participating institutions. Each site was asked to provide data relevant to its most recent 40 adult patient plasma transfusion episodes, and complete a questionnaire regarding plasma transfusion guidelines, utilization and wastage of plasma, and transfusion reactions related to plasma transfusion.
    RESULTS: - The participating institutions reported a total of 3383 evaluable plasma transfusion episodes with transfusion of 9060 units of plasma. Compliance with institution-specific guidelines was seen in 3018 events (89%). Pretransfusion and posttransfusion coagulation testing was done in 3281 (97%) and 3043 (90%) of these episodes, respectively. Inappropriate criteria were noted for more than 100 transfusion episodes. Thirty-two plasma transfusion episodes (1%) were associated with a transfusion reaction. Serious and fatal reactions were reported. Median plasma wastage rate for the year preceding the study was 4.5%.
    CONCLUSIONS: - Most participating institutions are compliant with plasma transfusion guidelines based on published references, supported by appropriate testing. With transfusions for indications that lack evidence of efficacy and incidence of transfusion reactions, there is an ongoing role for transfusion service leaders to continue to update and monitor plasma transfusion practices.

    PMID: 28234567 [PubMed - indexed for MEDLINE]

    Alcorn K, Ramsey G, Souers R, Lehman CM
  80. ICUD guidelines for upper tract urothelial carcinoma: a state-of-the-art evidence-based guidance for clinical decisions regarding diagnosis, management and treatment.

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

    Authors: Shariat SF

    PMID: 28197726 [PubMed - in process]

    Shariat SF
  81. Implementing Primary Prevention for Peanut Allergy at a Population Level.

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    JAMA. 2017 03 21;317(11):1111-1112

    Authors: Turner PJ, Campbell DE

    PMID: 28192569 [PubMed - indexed for MEDLINE]

    Turner PJ, Campbell DE
  82. Guidelines for Colorectal Cancer Testing: Evidence-Based Practice Recommendations.

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    J Mol Diagn. 2017 Mar;19(2):183-186

    Authors: Zehnbauer B, Temple-Smolkin R, Monzon FA

    Abstract
    This Editorial provides readers additional insight on the colorectal guideline appearing in this issue.

    PMID: 28190460 [PubMed - in process]

    Zehnbauer B, Temple-Smolkin R, Monzon FA
  83. 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.

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    J Sex Med. 2017 Mar;14(3):455-463

    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;14:455-463.

    PMID: 28189561 [PubMed - in process]

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

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    Nervenarzt. 2017 Mar;88(3):290

    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 - in process]

    Bandelow B, Lueken U, Wolff J, Godemann F, Wolff-Menzler C, Deckert J, Ströhle A, Beutel M, Wiltink J, Domschke K, Berger M
  85. 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.

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    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]

    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
  86. 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.

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    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]

    Adams RJ, Cox M, Ozark SD, Kanter J, Schulte PJ, Xian Y, Fonarow GC, Smith EE, Schwamm LH
  87. Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy.

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    Obstet Gynecol. 2017 Mar;129(3):448-456

    Authors: Teoh D, Isaksson Vogel R, Hultman G, Monu M, Downs L, Geller MA, Le C, Melton-Meaux G, Kulasingam S

    Abstract
    OBJECTIVE: To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups.
    METHODS: A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ and Wilcoxon rank-sum tests.
    RESULTS: A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1-54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7-43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1-31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group.
    CONCLUSION: For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.

    PMID: 28178049 [PubMed - in process]

    Teoh D, Isaksson Vogel R, Hultman G, Monu M, Downs L, Geller MA, Le C, Melton-Meaux G, Kulasingam S
  88. [Evidence-based guidelines : Cookbook medicine or key to better care?]

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    Z Rheumatol. 2017 Mar;76(2):102-103

    Authors: Zink A, Hellmich B

    PMID: 28154934 [PubMed - in process]

    Zink A, Hellmich B
  89. [Care for severely injured persons : Update of the 2016 S3 guideline for the treatment of polytrauma and the severely injured].

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    Anaesthesist. 2017 Mar;66(3):195-206

    Authors: Hilbert-Carius P, Wurmb T, Lier H, Fischer M, Helm M, Lott C, Böttiger BW, Bernhard M

    Abstract
    In 2011 the first interdisciplinary S3 guideline for the management of patients with serious injuries/trauma was published. After intensive revision and in consensus with 20 different medical societies, the updated version of the guideline was published online in September 2016. It is divided into three sections: prehospital care, emergency room management and the first operative phase. Many recommendations and explanations were updated, mostly in the prehospital care and emergency room management sections. These two sections are of special interest for anesthesiologists in field emergency physician roles or as team members or team leaders in the emergency room. The present work summarizes the changes to the current guideline and gives a brief overview of this very important work.

    PMID: 28138737 [PubMed - indexed for MEDLINE]

    Hilbert-Carius P, Wurmb T, Lier H, Fischer M, Helm M, Lott C, Böttiger BW, Bernhard M
  90. Greater Adherence to Cancer Prevention Guidelines Is Associated with Higher Circulating Concentrations of Vitamin D Metabolites in a Cross-Sectional Analysis of Pooled Participants from 2 Chemoprevention Trials.

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    J Nutr. 2017 Mar;147(3):421-429

    Authors: Kohler LN, Hibler EA, Harris RB, Oren E, Roe DJ, Jurutka PW, Jacobs ET

    Abstract
    Background: Several lifestyle factors targeted by the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines are also associated with circulating concentrations of vitamin D metabolites. This suggests that greater adherence to the ACS guidelines may be related to better vitamin D status.Objective: We examined the relation between adherence to the ACS guidelines and circulating concentrations of 2 vitamin D metabolites, 25-hydroxycholecalciferol [25(OH)D] and 1α,25-dihydroxyvitamin D [1,25(OH)2D].Methods: We conducted cross-sectional analyses of pooled participants from the Wheat Bran Fiber (n = 503) and Ursodeoxycholic Acid (n = 854) trials. A cumulative adherence score was constructed with the use of baseline data on body size, diet, physical activity, and alcohol consumption. Continuous vitamin D metabolite concentrations and clinically relevant categories were evaluated with the use of multiple linear and logistic regression models, respectively.Results: The most adherent participants were more likely to be older, white, and nonsmokers than were the least adherent. A statistically significant association was observed between guideline adherence and concentrations of circulating 25(OH)D (means ± SEs-high adherence: 32.0 ± 0.8 ng/mL; low adherence: 26.4 ± 0.7 ng/mL; P-trend < 0.001). For 1,25(OH)2D concentrations, high adherence was again significantly related to greater metabolite concentrations, with mean ± SE concentrations of 36.3 ± 1.3 pg/mL and 31.9 ± 1.0 pg/mL for high- and low-adherers, respectively (P-trend = 0.008). Furthermore, the odds of attaining a sufficient 25(OH)D status were 4.37 times higher for those most adherent than for those least adherent (95% CI: 2.47, 7.71 times).Conclusion: These findings demonstrate that greater adherence to the ACS guidelines is associated with higher circulating concentrations of both of 25(OH)D and 1,25(OH)2D.

    PMID: 28122932 [PubMed - in process]

    Kohler LN, Hibler EA, Harris RB, Oren E, Roe DJ, Jurutka PW, Jacobs ET
  91. Dutch guidelines for economic evaluation: 'from good to better' in theory but further away from pharmaceuticals in practice?

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    J R Soc Med. 2017 Mar;110(3):98-103

    Authors: Garattini L, Padula A

    PMID: 28116955 [PubMed - in process]

    Garattini L, Padula A
  92. Effect of an evidence-based guideline on the treatment of maxillofacial cancer: A prospective analysis.

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    J Craniomaxillofac Surg. 2017 Mar;45(3):427-431

    Authors: Wolff KD, Rau A, Ferencz J, Langer T, Kesting M, Nieberler M, Wesselmann S

    Abstract
    BACKGROUND: In 2012, a guideline for the diagnosis and treatment of oral cavity cancer based on the best available evidence was implemented at certified German cancer centres for head and neck carcinomas. The present analysis was performed to determine whether the implementation of the guideline via certification improved the level of care, leading to a benefit for the patients.
    METHODS: A prospective observational study was performed based on the annual operating figures at 31 certified head and neck cancer centres. From 76 statements and recommendations, 9 indicators were derived defining important steps during treatment. The annual shift of the figures was documented for each indicator and was used to measure the impact of the guideline. This was achieved by determining the number of patients having received the recommended treatment related to the total number in each centre over a period of 3 years.
    RESULTS: In 2014, 1570 primary cases with an oral cavity carcinoma were treated at our centres, 31.2% representing stage IVA. Except for two, all indicators showed increasing numbers of achievement from 2012 to 2014, reaching median values between 91% and 100% in 2014. In particular, median values for imaging and interdisciplinary treatment to evaluate the presence of second primaries and metastases increased by 20% and 30%, respectively. Median values decreased by 14% for recommended adjuvant radiation, because of non-acceptance by the patients. Moreover, elective neck dissection was performed less frequently in cN0 categories.
    CONCLUSIONS: Implementation of the national cancer guideline by means of certification evidently had a positive impact on patients suffering from oral squamous cell carcinoma and led to the improved achievement of most evidence-based treatment recommendations over time. Further research involving high-level clinical studies is needed to cover all aspects of this specific tumour entity.

    PMID: 28108238 [PubMed - in process]

    Wolff KD, Rau A, Ferencz J, Langer T, Kesting M, Nieberler M, Wesselmann S
  93. [New options for the practice : Update S1/S2 guidelines on rheumatoid arthritis?]

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    Z Rheumatol. 2017 Mar;76(2):125-132

    Authors: Schneider M

    Abstract
    Guidelines are important tools for evidence-based pharmacological treatment of patients suffering from rheumatoid arthritis. Recommendations assist physicians in identifying the best form of treatment but ultimately, the final decision is based on joint participation by the patient and physician. Nowadays, general concepts, such as treat to target seem to be more important in rheumatoid arthritis than differencies between various drugs or drug classes. The universal recommendation to use methotrexate as the initial disease-modifying antirheumatic drug (DMARD) is driven more by economic reasons than by scientific data, which is not completely wrong but should be disclosed. For the future, more differentiated recommendations need better individual risk stratification and more distinct profiling of the different substances.

    PMID: 28102443 [PubMed - in process]

    Schneider M
  94. Practice guidelines as implementation science: the journal editors' perspective.

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    Intensive Care Med. 2017 Mar;43(3):378-379

    Authors: Buchman TG, Azoulay E

    PMID: 28101606 [PubMed - in process]

    Buchman TG, Azoulay E
  95. Practice Guidelines as Implementation Science: The Journal Editors' Perspective.

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    Crit Care Med. 2017 Mar;45(3):553-554

    Authors: Buchman TG, Azoulay E

    PMID: 28099221 [PubMed - in process]

    Buchman TG, Azoulay E
  96. Prophylaxis of Venous Thrombosis in Neurocritical Care Patients: An Executive Summary of Evidence-Based Guidelines: A Statement for Healthcare Professionals From the Neurocritical Care Society and Society of Critical Care Medicine.

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    Crit Care Med. 2017 Mar;45(3):476-479

    Authors: Nyquist P, Jichici D, Bautista C, Burns J, Chhangani S, DeFilippis M, Goldenberg FD, Kim K, Liu-DeRyke X, Mack W, Meyer K

    PMID: 28085682 [PubMed - in process]

    Nyquist P, Jichici D, Bautista C, Burns J, Chhangani S, DeFilippis M, Goldenberg FD, Kim K, Liu-DeRyke X, Mack W, Meyer K
  97. [Evidence-based recommendations for diagnostics and treatment of gouty arthritis in the specialist sector : S2e guidelines of the German Society of Rheumatology in cooperation with the AWMF].

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    Z Rheumatol. 2017 Mar;76(2):118-124

    Authors: Kiltz U, Alten R, Fleck M, Krüger K, Manger B, Müller-Ladner U, Nüsslein H, Reuss-Borst M, Schwarting A, Schulze-Koops H, Tausche AK, Braun J

    Abstract
    Due to the increasing prevalence of gout, particularly in old age, the disease is becoming of increasing importance in Germany. Gout is one of the most common forms of recurrent inflammatory arthritis and is induced by the deposition of monosodium urate crystals in synovial fluid and other tissues. The principal goals of therapy in chronic gout are the symptomatic treatment of the acute joint inflammation and the causal treatment of the underlying metabolic cause, the hyperuricemia. Only a consistent and permanent reduction of the serum uric acid level ultimately results in an efficient avoidance of further gout attacks and therefore the prevention of structural damage. Due to an often inadequate treatment of gout, the target of healing the disease is often not achieved. A correct and timely diagnosis and adequate assessment of comorbidities associated with gout are, however, of substantial importance for patient and physician to achieve remission of the disease. In order to create a solid basis for a timely and effective treatment of affected patients, in 2016 the German Society of Rheumatology (DGRh) initiated the development of S2e guidelines on gouty arthritis for specialists. This article summarizes these S2e guidelines on the management of gouty arthritis in the specialist sector.

    PMID: 28078432 [PubMed - in process]

    Kiltz U, Alten R, Fleck M, Krüger K, Manger B, Müller-Ladner U, Nüsslein H, Reuss-Borst M, Schwarting A, Schulze-Koops H, Tausche AK, Braun J
  98. RE: Radiological assessment of paediatric cervical spine injury in blunt trauma: the potential impact of new NICE guidelines on the use of CT. A reply.

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    Clin Radiol. 2017 Mar;72(3):263-264

    Authors: Davies J, Cross S, Evanson J

    PMID: 28065640 [PubMed - in process]

    Davies J, Cross S, Evanson J
  99. Re: Radiological assessment of paediatric cervical spine injury in blunt trauma: the potential impact of new NICE guideline on the use of CT.

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    Clin Radiol. 2017 Mar;72(3):262-263

    Authors: Andronikou S, Hussien M

    PMID: 28038778 [PubMed - in process]

    Andronikou S, Hussien M
  100. Identification and Management of Mental Health Problems and Integration of Care for Adults in Contact with the Criminal Justice System

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    Book. 2017 03

    Authors: National Guideline Alliance (UK)

    Abstract
    This guideline has been developed to advise on identification and management of mental health problems and integration of care for adults in contact with the criminal justice system. The guideline recommendations have been developed after careful consideration of the best available evidence by a multidisciplinary team of healthcare professionals, criminal justice system professionals, people with mental health problems who have been in contact with the criminal justice system, their carers and guideline methodologists. It is intended that the guideline will be useful to clinicians and service commissioners in the identification and management of mental health problems and integration of care for adults in contact with the criminal justice system (see Appendix A for more details on the scope of the guideline). Although the evidence base is rapidly expanding, there are a number of significant gaps. The guideline makes a number of research recommendations specifically to address gaps in the existing evidence base. In the meantime, this guideline aims to assist clinicians and people with mental health problems in contact with the criminal justice system and their carers, by identifying the merits of particular identification treatment and management approaches where the evidence from research and clinical experience exists.


    PMID: 28350429

    National Guideline Alliance (UK)
zuletzt verändert: 02.04.2017 19:34