Adherence to guidelines for prevention of postsplenectomy sepsis. Age and sex are risk factors: a five-year retrospective review.

ANZ J Surg. 2006 Jul;76(7):542-7

Authors: Kotsanas D, Al-Souffi MH, Waxman BP, King RW, Polkinghorne KR, Woolley IJ

BACKGROUND: Vaccination, education and use of long-term antibiotics are recommended in expert guidelines for the prevention of infectious complications after splenectomy. However, studies outside Australia have shown poor adherence to the guidelines. METHOD: The aim of this study was to determine overall adherence to the guidelines and to ascertain any independent risk factors for poor compliance with the guidelines. A retrospective review of hospital records between 1999 and 2004 was carried out. RESULTS: Indications for splenectomy of the 111 patients in this review included post-trauma (32), haematological (32), cancer surgery (24), iatrogenic (12) and others (11). On multivariable analysis, age was associated with a 28% less likelihood to receive education (odds ratio (OR) 0.72; 95% confidence interval (CI) 0.56-0.92; P = 0.009) and 36% less likelihood to receive long-term antibiotics (OR 0.64; 95% CI 0.52-0.80; P

PMID: 16813615 [PubMed - indexed for MEDLINE]

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Availability, content and quality of local guidelines for the assessment of suicide attempters in university and general hospitals in the Netherlands.

Gen Hosp Psychiatry. 2006 Jul-Aug;28(4):336-42

Authors: Verwey B, van Waarde JA, van Rooij IA, Gerritsen G, Zitman FG

OBJECTIVE: This study was performed to investigate the availability, content and quality of local guidelines for the assessment of suicide attempters in the Netherlands. METHOD: All university and general hospitals in the Netherlands were asked to provide their local guidelines. Published national guidelines and the Appraisal of Guidelines for Research and Education (AGREE) instrument were used to evaluate the content and quality of the local guidelines. RESULTS: Eighty-eight hospitals (90.7%) responded; 34 (38.6%) reported that they used local guidelines. Twenty-seven guidelines were submitted for evaluation. Most of the guidelines were more than 5 years old and had not been updated recently. The contents of the guidelines differed. Criteria addressing patient safety, staff attitude toward patients, reassessment of nonalert patients, relevant stressors, involvement of significant others and aftercare were found in less than 50% of the guidelines. Although psychiatric consultation was incorporated in almost 80%, the psychiatrist’s tasks were specified infrequently. The guidelines seldom required monitoring of staff compliance. Only in the AGREE domain “clarity and presentation” was the mean score above 60% of the maximum. According to the instructions for the AGREE instrument, 10 (37.0%) of the 27 guidelines were recommended (with provisos or alterations) and 1 was strongly recommended for use in practice. CONCLUSIONS: In the Netherlands, a minority of hospitals reported use of local guidelines for the assessment of suicide attempters. When available, the guidelines were mostly not based on international standards, their contents varied greatly and their quality was unsatisfactory.

PMID: 16814634 [PubMed - in process]

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Very early prophylactic thyroid surgery for infants with a mutation of the RET proto-oncogene at codon 634: evaluation of the implementation of international guidelines for MEN type 2 in a single centre.

Clin Endocrinol (Oxf). 2006 Jul;65(1):118-24

Authors: Piolat C, Dyon JF, Sturm N, Pinson S, Bost M, Jouk PS, Plantaz D, Chabre O

OBJECTIVE: Genetic diagnosis available since 1993 established germinal mutations of the RET proto-oncogene at codon 634 as the main cause of inherited medullary thyroid carcinoma (MTC). International guidelines established in 1999 recommend that children with such mutations undergo a total thyroidectomy before age 5, with unspecified cervical neck dissection. Since 1993, only 41 of 275 thyroidectomies reported in RET 634 children were performed before age 5 (15%). The aim of this study was to evaluate the implementation of these guidelines in a single centre. DESIGN AND PATIENTS: Genetic diagnosis was proposed to the parents of all eight children born after 1992 from two RET 634 families. Total thyroidectomy was proposed before age 5 if the child carried a mutation. RESULTS: Genetic diagnosis was performed in all the children (aged 1-3) and thyroidectomy in the five who carried a mutation (aged 2-5). Cervical lymph node dissection varied from lymphadenectomy of central and lateral compartments in the eldest child to pickings in the youngest. There was no permanent hypoparathyroidism or recurrent nerve paralysis. C-cell hyperplasia, medullary thyroid carcinoma and lymph node metastasis were present in 5/5, 3/5 and 0/5, respectively. Undetectable pentagastrin-stimulated CT levels were achieved and maintained postoperatively in all five children (average follow-up 3.6 years). CONCLUSIONS: MEN 2 guidelines on thyroidectomy can be efficiently and safely implemented by a multidisciplinary team operating in a single centre. The lack of guidelines on cervical neck dissection remains a problem; this could be solved by determining an age under which this procedure would be deemed unnecessary.

PMID: 16817830 [PubMed - in process]

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Rationale and design of the National Benchmarking and Evidence-based National Clinical Guidelines for Chronic Heart Failure Management Programs Study.

J Cardiovasc Nurs. 2006 Jul-Aug;21(4):276-82

Authors: Driscoll A, Worrall-Carter L, Stewart S

OBJECTIVES: The National Benchmarks and Evidence-Based National Clinical Guidelines for Heart Failure Management Programs Study is a national, multicenter study designed to determine the nature, range, and effect of interventions applied by chronic heart failure management programs (CHF-MPs) throughout Australia on patient outcomes. Its primary objective is to use these data to develop national benchmarks and evidence-based clinical guidelines and optimize their cost-effective application by reducing quality and outcome variability. DATA SOURCES/STUDY SETTING: Primary data will be collected from CHF-MP coordinators and CHF patients enrolled in these programs on a national basis. Secondary outcome data will be collected from a national morbidity record and from patients’ medical records. STUDY DESIGN: Stage I of the study involves a prospective clinical audit of all CHF-MPs throughout Australia (n = 45) to determine the extent of variability in programs currently. Stage II is a prospective cross-sectional survey design enrolling 1,500 patients (average of 40 patients per program) to firstly determine the typical profile of patients being managed via a CHF-MP in Australia and, secondly, the subsequent morbidity and mortality during the 6-month follow-up. Outcome data will be subject to multivariate analysis to determine the key components of care in this regard. All study data will be then examined in the final stage of the study (III) to develop national benchmarks for the application and auditing of CHF-MPs in Australia. CONCLUSION: Variability in patient outcomes is a product of heterogeneity among CHF-MPs. The development of national benchmarks will minimize such heterogeneity and will provide a greater level of evidence for their cost-effective application.

PMID: 16823280 [PubMed - indexed for MEDLINE]

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Clinical characteristics, process of care, and outcomes of Hispanic patients presenting with non-ST-segment elevation acute coronary syndromes: results from Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE).

Am Heart J. 2006 Jul;152(1):110-7

Authors: Cohen MG, Roe MT, Mulgund J, Peterson ED, Sonel AF, Menon V, Smith SC, Saucedo JF, Lytle BL, Pollack CV, Garza L, Gibler WB, Ohman EM

BACKGROUND: Data regarding the management of non-ST-segment elevation acute coronary syndromes (NSTE ACS) in Hispanic patients, the largest and fastest-growing minority in the United States, are scarce. METHODS: We sought to describe the clinical characteristics, process of care, and outcomes of Hispanics presenting with NSTE ACS at US hospitals. We compared baseline characteristics, resource use, and inhospital mortality among 3936 Hispanics and 90280 non-Hispanic whites with NSTE ACS from the CRUSADE Quality Improvement Initiative. RESULTS: The regional distribution of Hispanics in CRUSADE paralleled that in the US Census. Hispanics were younger (65 vs 70 years, P

PMID: 16824839 [PubMed - indexed for MEDLINE]

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The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative.

Am Heart J. 2006 Jul;152(1):140-8

Authors: Diercks DB, Roe MT, Mulgund J, Pollack CV, Kirk JD, Gibler WB, Ohman EM, Smith SC, Boden WE, Peterson ED

BACKGROUND: Although obesity is a known risk factor for coronary artery disease, its impact on the presentation, treatment, and outcome of patients with acute coronary syndromes (ACS) has not been well studied. METHODS: Using data from the CRUSADE Initiative, we compared inhospital treatments and clinical outcomes of 80845 patients with high-risk non-ST-segment elevation (NSTE) ACS (positive cardiac markers and/or ischemic ST-segment changes) to determine whether there was an association with body mass index (BMI [kg/m2]). Patient weights were categorized according to World Health Organization classifications: Underweight (BMI

PMID: 16824844 [PubMed - indexed for MEDLINE]

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Assessing the impact of asthma guideline implementation.

Chest. 2006 Jul;130(1):5-6

Authors: Stempel DA

PMID: 16840373 [PubMed - indexed for MEDLINE]

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Impact of antibiotic guideline compliance on duration of mechanical ventilation in critically ill patients with community-acquired pneumonia.

Chest. 2006 Jul;130(1):93-100

Authors: Shorr AF, Bodi M, Rodriguez A, Sole-Violan J, Garnacho-Montero J, Rello J,

OBJECTIVE: Multiple guidelines exist to aid clinicians in choosing antibiotics to treat patients with severe community-acquired pneumonia (SCAP). Our goal was to assess the impact of following these guidelines, such as those from the Infectious Disease Society of America (IDSA), on the duration of mechanical ventilation (MV). DESIGN: Analysis of a prospective registry. SETTING: Multiple ICUs in Spain. PATIENTS: ICU patients with SCAP requiring > or = 24 h of endotracheal intubation and surviving their ICU course. INTERVENTIONS: None.Measurements and main results: Demographics, comorbid diseases, severity of illness, and process of care variables were recorded. The duration of MV in patients receiving an antibiotic regimen consistent with IDSA guidelines was compared to patients with prescriptions not in accordance with IDSA recommendations. In the cohort (n = 199), Streptococcus pneumoniae was the most frequent pathogen, and unadjusted analysis showed that the duration of MV was longer in persons receiving IDSA-noncompliant regimens (11 days vs 10 days). In a multivariate hazard model, two variables were independently associated with greater durations of MV: development of acute renal failure (hazard ratio, 1.47; 95% confidence interval [CI], 1.02 to 2.12), and prescription of an IDSA-noncompliant regimen (hazard ratio, 1.40; 95% CI, 1.02 to 1.93). Adjusted analysis indicated that patients receiving treatment that was not compliant with IDSA guidelines received MV an added 3 days. CONCLUSION: Failure to follow antibiotic recommendations for the treatment of SCAP may increase the need for continuing MV. Conversely, guideline compliance could represent a surrogate marker that captures other aspects of clinical care, rather than be the direct factor leading to better outcomes. Nonetheless, given the costs associated with MV, enhanced guideline compliance may represent a means for improving outcomes and enhancing resource utilization.

PMID: 16840388 [PubMed - indexed for MEDLINE]

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Dissemination and implementation of guidelines for the treatment of asthma.

Int J Tuberc Lung Dis. 2006 Jul;10(7):710-6

Authors: Tan WC, Aït-Khaled N

Asthma remains a serious global health problem that affects people of all ages. Many asthma management guidelines, both national and international, are available, but they are seldom implemented. The implementation of guidelines remains a challenge worldwide, as barriers exist at several levels. These barriers are generic, such as poverty, inadequate resources and poor infrastructure, or specific, such as organisational, health care provider and patient factors. The barriers are, however, potentially correctable, and the goal of guideline implementation is to translate evidence-based asthma management recommendations into real-life practice to improve patient health. This state of the art article reviews the challenges and current status of and strategies for asthma dissemination and implementation globally, and highlights the specific strategies for such improvement in developing countries.

PMID: 16848330 [PubMed - in process]

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Evidence-based guideline. Improving medication management for older adult clients.

J Gerontol Nurs. 2006 Jul;32(7):6-14

Authors: Bergman-Evans B

All providers and professionals who care for older adults have an important role to play in the process of managing medications. The evidence-based guideline “Improving Medication Management for Older Adult Clients” (Bergman-Evans, 2004) provides assessments and interventions that are useful across settings. By focusing on reducing inappropriate prescribing, decreasing polypharmacy, avoiding adverse events, and maintaining function, professionals and providers have the opportunity to improve outcomes for this important population.

PMID: 16863041 [PubMed - indexed for MEDLINE]

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