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EFNS guidelines on diagnosis and management of neuromyelitis optica.

Eur J Neurol. 2010 Aug;17(8):1019-32

Authors: Sellner J, Boggild M, Clanet M, Hintzen RQ, Illes Z, Montalban X, Du Pasquier RA, Polman CH, Sorensen PS, Hemmer B

BACKGROUND AND PURPOSE: Neuromyelitis optica (NMO) or Devic's disease is a rare inflammatory and demyelinating autoimmune disorder of the central nervous system (CNS) characterized by recurrent attacks of optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM), which is distinct from multiple sclerosis (MS). The guidelines are designed to provide guidance for best clinical practice based on the current state of clinical and scientific knowledge. SEARCH STRATEGY: Evidence for this guideline was collected by searches for original articles, case reports and meta-analyses in the MEDLINE and Cochrane databases. In addition, clinical practice guidelines of professional neurological and rheumatological organizations were studied. RESULTS: Different diagnostic criteria for NMO diagnosis [Wingerchuk et al. Revised NMO criteria, 2006 and Miller et al. National Multiple Sclerosis Society (NMSS) task force criteria, 2008] and features potentially indicative of NMO facilitate the diagnosis. In addition, guidance for the work-up and diagnosis of spatially limited NMO spectrum disorders is provided by the task force. Due to lack of studies fulfilling requirement for the highest levels of evidence, the task force suggests concepts for treatment of acute exacerbations and attack prevention based on expert opinion. CONCLUSIONS: Studies on diagnosis and management of NMO fulfilling requirements for the highest levels of evidence (class I-III rating) are limited, and diagnostic and therapeutic concepts based on expert opinion and consensus of the task force members were assembled for this guideline.

PMID: 20528913 [PubMed - in process]

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Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomas.

J Vasc Interv Radiol. 2010 Aug;21(8):1153-63

Authors: Stokes LS, Wallace MJ, Godwin RB, Kundu S, Cardella JF

PMID: 20558083 [PubMed - in process]

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The revised American Thyroid Association management guidelines 2009 for patients with differentiated thyroid cancer: an evidence-based risk-adapted approach.

Clin Oncol (R Coll Radiol). 2010 Aug;22(6):472-4

Authors: Mallick UK,

PMID: 20576407 [PubMed - in process]

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Pragmatic evidence and textual arrangements: a case study of French clinical cancer guidelines.

Soc Sci Med. 2010 Aug;71(4):685-92

Authors: Knaapen L, Cazeneuve H, Cambrosio A, Castel P, Fervers B

Both critics and supporters of evidence-based medicine view clinical practice guidelines as an important component of this self-defined "new paradigm" whose goal is to rationalize medicine by grounding clinical decision-making in a careful assessment of the medical literature. We present an analysis of the debates within a guideline development group (GDG) that led to the drafting, revision and publication of a French cancer guideline. Our ethnographic approach focuses on the various aspects of the dispositif (or apparatus) that defines the nature and roles of participants, procedures, topics and resources within the GDG. Debates between GDG members are framed (but not dictated) by procedural and methodological rules as well as by the reflexive critical contributions of the GDG members themselves, who justify their (tentative) recommendations by relating to its (possible or intended) audiences. Guideline production work cannot be reduced to an exchange of arguments and to consensus-seeking between pre-defined professional interests. It is about the production of a text in the material sense of the term, i.e. as a set of sentences, paragraphs, statements and formulations that GDG members constantly readjust and rearrange until closure is achieved. As such, guidelines partake in the emergence and stabilization of a new configuration of biomedical knowledge and practices grounded in the establishment of mutually constitutive links between two processes: on the one hand, the re-formatting of clinical trials into a device for producing carefully monitored evidence statements targeting specific populations and clinical indications and, on the other hand, the increasingly pervasive role of regulatory processes.

PMID: 20646809 [PubMed - in process]

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Consultative DXA Reporting Improves Guideline-Driven Quality of Care-Implications for Increasing DXA Reimbursement.

J Clin Densitom. 2010 July - September;13(3):315-319

Authors: Oppermann B, Ayoub W, Newman E, Wood GC, Olenginski TP

Since 2001, Geisinger Health System densitometrists have interpreted dual-energy X-ray absorptiometries (DXAs) in a guideline-driven, consultative fashion. We believe that this approach results in more patients receiving appropriate treatment. Recently, one of our DXA centers chose to stop consultative reporting, providing us an opportunity to review the care rendered with 2 different styles of DXA reporting formats: Consultative vs Results Only. In this retrospective chart review, 100 consecutive DXAs with Consultative reporting and 100 consecutive DXAs with Results Only reporting were identified. The electronic health record was reviewed for a 3-mo interval after DXA result to identify whether a prescription medication was prescribed per system guidelines. Logistic regression compared the proportion of patients receiving a prescription treatment between the 2 groups. The Consultative report group received more prescription treatment compared with Results Only format (72% vs 50%) after controlling for patients' age and gender, odds ratio=2.64, 95% confidence interval=1.45-4.79 (p=0.0014). Our study demonstrates that Consultative DXA reporting results in better care. Importantly, Consultative reporting takes additional time; yet, reimbursement for these efforts and expertise has been dramatically reduced. To appropriately reward the value of DXA testing and interpretation, Consultative reporting should be reimbursed at the previous higher reimbursement rate.

PMID: 20605498 [PubMed - as supplied by publisher]

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Educational interventions for implementation of arthritis clinical practice guidelines in primary care: effects on health professional behavior.

J Rheumatol. 2010 Aug;37(8):1562-9

Authors: Lineker SC, Husted JA

OBJECTIVE: The dissemination and adoption of clinical practice guidelines (CPG) has been suggested as one method for improving arthritis care delivery. This article provides a review and synthesis of studies evaluating the influence of educational programs designed to implement CPG for osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care. METHODS: A systematic literature search was conducted to identify relevant educational interventions that reported behavioral outcomes that ensured actual knowledge utilization in primary care. A standardized approach was used to assess the quality of the individual studies and a modified version of the Philadelphia Panel methodology allowed for grading of studies based on strength of design, clinical relevance, and statistical significance. RESULTS: The search identified 485 articles; 7 studies were selected for review. In OA, peer facilitated workshops with nurse case-management support for patients decreased the number of referrals to orthopedics by 23%, and educational outreach by trained physicians improved prescribing of analgesics. Interprofessional peer facilitated workshops were successful in increasing referrals to rehabilitation services for people with OA and RA. CONCLUSION: There was sparse literature on educational programs for the implementation of arthritis CPG in the primary care environment. Future studies are needed to evaluate which specific organizational, provider, patient, and system level factors influence the uptake of arthritis CPG in primary care.

PMID: 20595274 [PubMed - in process]

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Community pharmacists' involvement in smoking cessation: implementation of the National smoking cessation guideline in Finland.

BMC Public Health. 2010 Jul 29;10(1):444

Authors: Kurko T, Linden K, Pietila K, Sandstrom P, Airaksinen M

ABSTRACT: BACKGROUND: Guidelines on smoking cessation (SC) emphasize healthcare cooperation and community pharmacists' involvement. This study explored the familiarity and implementation of the national SC Guideline in Finnish community pharmacies, factors relating to Guideline familiarity, implementation and provision of SC services. METHODS: A nationwide mail survey was sent to a systematic, sample of community pharmacy owners and staff pharmacists (total n=2291). Response rate was 54% (n=1190). Factors related to the SC Guideline familiarity were assessed by bivariate and multivariate analysis. RESULTS: Almost half (47%) of the respondents (n=1190) were familiar with the SC Guideline and familiarity enhanced Guideline implementation. The familiarity was associated with the respondents' perceptions of their personal SC skills and knowledge (OR 3.8); of customers' value of counseling on nicotine replacement therapy (NRT) (OR 3.3); and regular use of a pocket card supporting SC counseling (OR 3.0). Pharmacists' workplaces' characteristics, such as size and geographical location were not associated with familiarity. In addition to recommending NRT, the pharmacists familiar with the Guideline used more frequently other Guideline-based SC methods, such as recommended non-pharmacological SC aids, compared to unfamiliar respondents. CONCLUSIONS: SC Guideline familiarity and implementation is crucial for community pharmacists' involvement in SC actions in addition to selling NRT products. Pharmacists can constitute a potential public health resource in SC easily accessible throughout the country.

PMID: 20670409 [PubMed - as supplied by publisher]

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[Sedation in palliative medicine: Guidelines for the use of sedation in palliative care : European Association for Palliative Care (EAPC).]

Schmerz. 2010 Jul 28;

Authors: Alt-Epping B, Sitte T, Nauck F, Radbruch L

The European Association for Palliative Care (EAPC) considers sedation to be an important and necessary therapy option in the care of selected palliative care patients with otherwise refractory distress. Prudent application of this approach requires due caution and good clinical practice. Inattention to potential risks and problematic practices can lead to harmful and unethical practice which may undermine the credibility and reputation of the responsible clinicians and institutions as well as the discipline of palliative medicine more generally. Procedural guidelines are helpful to educate medical providers, set standards for best practice, promote optimal care and convey the important message to staff, patients and families that palliative sedation is an accepted, ethical practice when used in appropriate situations. EAPC aims to facilitate the development of such guidelines by presenting a 10-point framework that is based on the pre-existing guidelines and literature and extensive peer review.

PMID: 20661593 [PubMed - as supplied by publisher]

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[Nothing is more damaging to a new truth than an old error : Conformity of new guidelines on opioid administration for chronic pain with the effect prognosis of the DGSS S3 guidelines LONTS (long-term administration of opioids for non-tumor pain).]

Schmerz. 2010 Jul 28;

Authors: Sorgatz H, Maier C

PMID: 20661594 [PubMed - as supplied by publisher]

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Ratification of IATSIC/WHO's Guidelines for Essential Trauma Care Assessment in the South American Region.

World J Surg. 2010 Jul 27;

Authors: Aboutanos MB, Mora F, Rodas E, Salamea J, Parra MO, Salgado E, Mock C, Ivatury R

BACKGROUND: The purpose of the present study was to evaluate the usefulness of the International Association for Trauma Surgery and Intensive Care (IATSIC)/World Health Organization (WHO)'s Guidelines for Essential Trauma Care (EsTC Guidelines) in providing an internationally applicable and standardized template to assess trauma care capabilities in the South American Region. METHODS: Field assessment was conducted in seven provinces (urban and rural, pop. 2,239,509) and 24 facilities (5 large hospitals (LH); 15 small hospitals (SH); 4 basic hospitals (BH)) in Ecuador using EsTC criteria. A total of 260 individual items in Human Resources (HR- availability, clinical knowledge, skills) and physical resources (PR) were evaluated via inspection, review of local statistics, and administrative and staff interviews. EsTC was evaluated on a scale as follows: 0 (absent); 1(inadequate; < 50%); 2 (partly adequate > 50%); 3 (adequate-100%). RESULTS: 210,045 Emergency Department (ED) visits and 61,365 (29%) ED trauma visits were recorded (incidence rate 2,740/100,000 population). Deficits were noted in prehospital trauma care (inadequate coordination, communication), education and training (ATLS < 30%, TNCC 0%), facility based trauma care (poor physical resources [PR] and human resources [HR]), and quality assurance (1/27 hospitals). CONCLUSIONS: The IATSIC/WHO EsTC Guidelines provide a simple and useful template to assess trauma care capability in variable facilities and international settings, and they could serve as a valuable tool for trauma system development. Endorsement of EsTC Guidelines by the Panamerican Health Organization and lead trauma societies (the Panamerican Trauma Society) should be considered.

PMID: 20661563 [PubMed - as supplied by publisher]

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