Liebe Leser,
durch ein technisches Problem haben einige E-Mail-Abonnenten längere Zeit keine und statt dessen am 29.10.2006 eine größere Zahl Administrations-Emails des Online-Newsletters “Effekte von Leitlinien” bekommen.
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Ihr ÄZQ-Newsletter-Team

Inconsistent grading of evidence across countries: a review of low back pain guidelines.

J Manipulative Physiol Ther. 2006 Sep;29(7):576-81, 581.e1-2

Authors: Murphy AY, van Teijlingen ER, Gobbi MO

OBJECTIVE: The aim of this study was to report clinical treatment recommendations for low back pain (LBP) based on 5 international guidelines and best evidence from the Cochrane database of systematic reviews. METHODS: Five LBP guidelines available in English language were appraised, including 4 studies published since the seminal work by Koes et al (Spine 2001;26:2504-5213). The guidelines were examined for treatment recommendations concerning nonspecific LBP and guideline quality with application of the Appraisal of Guidelines for Research and Evaluation instrument. Secondly, a systematic literature search for reviews and randomized controlled trials was conducted using a modified version of the search strategy recommended by the Cochrane Back Review Group. Two systematic reviews were identified. RESULTS: According to best evidence from review of the Cochrane database of systematic reviews, there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment of nonspecific LBP. Furthermore, the guidelines reviewed in the present study have not changed significantly with respect to treatment recommendations for nonspecific LBP since the original review, and there is inconsistency between the guidelines regarding optimal time to introduce spinal manipulation to treat nonspecific LBP. CONCLUSION: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence.

PMID: 16949948 [PubMed - indexed for MEDLINE]

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Bioethics in China: although national guidelines are in place, their implementation remains difficult.

EMBO Rep. 2006 Sep;7(9):850-4

Authors: Hennig W

PMID: 16953195 [PubMed - indexed for MEDLINE]

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Mothering an infant: evidence-based guidelines for clinical assessment and interventions.

J Obstet Gynecol Neonatal Nurs. 2006 Sep-Oct;35(5):648

Authors: Logsdon MC

PMID: 16958721 [PubMed - in process]

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Considered judgement in evidence-based guideline development.

Int J Qual Health Care. 2006 Oct;18(5):365-9

Authors: Verkerk K, Van Veenendaal H, Severens JL, Hendriks EJ, Burgers JS

BACKGROUND: Clinical practice guidelines should be based on the best available evidence. However, this evidence is often incomplete, controversial, or lacking. Other considerations beyond the evidence are therefore needed to be able to formulate specific and applicable recommendations for clinical practice. OBJECTIVE: The aim of this study is to obtain consensus among experts about a set of domains and items covering the most relevant ‘other considerations’ to formulate recommendations in evidence-based guideline development. METHODS: An initial list of 10 domains and 49 items for a systematic and considered judgement of scientific evidence was generated from the literature. A panel of Dutch experts in guideline development tested this list using a two-round Delphi consensus technique. Each expert was asked to independently score the relevance of the items on a 4-point Likert scale, ranging from ‘very important’ to ‘not important’. The final list consisted of items that were included by at least 60% consensus. RESULTS: Twenty-eight experts participated in the first Delphi round and 21 of them in the second round. High scoring domains were ‘clinical relevance’, ’safety’, and ‘availability of resources’. There was consensus about the relevance of 37 items. The domain ‘conflicts of interest by industry’ was excluded because of lack of consensus. CONCLUSION: This is the first formal consensus approach towards structuring the considered judgement process in formulating recommendations in clinical guidelines. The final list of items can be used to facilitate the process of guideline development. The next step is to test the practical usefulness and applicability of this list in guideline development.

PMID: 16959800 [PubMed - in process]

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The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit.

Intensive Care Med. 2006 Oct;32(10):1506-14

Authors: Elliott R, McKinley S, Aitken LM, Hendrikz J

OBJECTIVE: To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU. DESIGN AND SETTING: The intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit. PATIENTS: Adult mechanically ventilated patients were selected consecutively (n[Symbol: see text]=[Symbol: see text]322). The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group. INTERVENTION: An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy. MEASUREMENTS AND RESULTS: The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P[Symbol: see text]=[Symbol: see text]0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P[Symbol: see text]=[Symbol: see text]0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used. CONCLUSIONS: The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.

PMID: 16896847 [PubMed - in process]

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Development of quality indicators for diagnosis and treatment of patients with non-small cell lung cancer: a first step toward implementing a multidisciplinary, evidence-based guideline.

Lung Cancer. 2006 Oct;54(1):117-24

Authors: Hermens RP, Ouwens MM, Vonk-Okhuijsen SY, van der Wel Y, Tjan-Heijnen VC, van den Broek LD, Ho VK, Janssen-Heijnen ML, Groen HJ, Grol RP, Wollersheim HC

BACKGROUND: While developing and distributing clinical practice guidelines are important in optimising clinical healthcare, insight into actual care is necessary to achieve successful implementation. Developing quality indicators may be the first step to becoming aware of actual care. The Dutch national practice guideline Non-small cell lung cancer: staging and treatment is one of the first clinical, multidisciplinary guidelines for oncology in the Netherlands for which quality indicators were developed systematically. We describe indicator development based on this guideline as a practical experience. METHODS: To develop a set of indicators for diagnosis and treatment of patients with non-small cell lung cancer, we systematically achieved consensus on the basis of a national, multidisciplinary, evidence-based guideline and the opinions of professionals and patients. After the researchers extracted the recommendations from the guideline, we carried out a so-called Rand-modified-Delphi procedure. This consisted of three rounds: a national panel of professionals and representatives of the national patient organization scored all recommendations, the professionals had a consensus meeting, and the final set of indicators was e-mailed for a last check. Subsequently, some clinimetric characteristics of this final set were assessed in a practice test. RESULTS: Thirty-two of 83 recommendations were selected in the first round. After the consensus meeting, 8 recommendations met the final criteria and were incorporated into 15 indicators, which were tested in practice. The most successful indicators for quality improvement are indicators that are measurable, have potential for improvement, have a broad range between practices and are applicable to a large part of the population. CONCLUSIONS: For successful implementation of evidence-based guidelines, each new guideline should be developed and tested with a set of indicators based on the guideline. The procedure we describe can serve as an example for other new guidelines.

PMID: 16920220 [PubMed - in process]

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Evaluation of a multiple component intervention to support the implementation of a ‘Therapeutic Relationships’ best practice guideline on nurses’ communication skills.

Patient Educ Couns. 2006 Oct;63(1-2):3-11

Authors: Edwards N, Peterson WE, Davies BL

OBJECTIVE: To determine if there was an improvement in nurses’ communication skills 5 months after a multiple component intervention to implement the Registered Nurses’ Association of Ontario best practice guideline ‘Establishing Therapeutic Relationships’. METHODS: A matched pair, before and after design was used. Eight client scenarios with corresponding client comments were read aloud to nurses who were asked to respond verbally, as though they were interacting with the client. Responses were audio-taped and transcribed. The frequency and quality of nurses’ active listening, initiating and assertiveness skills were measured pre- and post-implementation of the guideline. RESULTS: Twenty-two nurses responded at both time points. Active listening skills were most frequently used. There was a statistically significant decrease in the number of active listening skills used, but a statistically significant improvement in the quality of active listening and initiating statements and frequency of initiating skills. CONCLUSION: Nurses demonstrated improvements in selected communication skills following the implementation of a multiple component intervention that included a best practice guideline. PRACTICE IMPLICATIONS: A combination of strategies that support the implementation of a best practice guideline is described. Results indicate some improvement in communication skills that are essential to the establishment of therapeutic nurse-client relationships.

PMID: 16935459 [PubMed - in process]

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The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals.

Eur J Anaesthesiol. 2006 Nov;23(11):962-70

Authors: Lemmens LC, van Klei WA, Klazinga NS, Rutten CL, van Linge RH, Moons KG, Kerkkamp HE

SummaryBackground and objectives: Preoperative evaluation performed by anaesthesiologists primarily aims to estimate the risk of perioperative complications and to create opportunities to optimize the patients’ condition before surgery. In this study an inventory was made of the current practice of preoperative evaluation in Dutch hospitals. It was estimated how many hospitals had implemented an outpatient preoperative evaluation clinic in 2004. Subsequently, current practice was compared with the results of a previous inventory (2000). It was also evaluated to what extent the guidelines of the Dutch Health Council and the Netherlands Society of Anaesthesiology were followed. Methods: The study consisted of two phases. First, a literature research was performed and pilot interviews were constructed. The interviews were conducted face-to-face with anaesthesiologists in a sample of Dutch hospitals. Based on the results, written questionnaires were constructed. In the second phase these questionnaires were sent to all general and academic hospitals in the Netherlands. Results: In 2004, 74% of the hospitals had an outpatient preoperative evaluation clinic, compared with 50% in 2000. The percentage of hospitals with an outpatient preoperative evaluation clinic available for all elective patients increased from 20% to 52%. Conclusions: The Dutch guidelines on preoperative evaluation seem to have influenced current practice. An increase in the number of outpatient preoperative evaluation clinics was seen after the guidelines were published. The implementation of an outpatient preoperative clinic seems to warrant that anaesthesiologists are carrying out the activities prescribed by the guidelines. Most hospitals without a clinic aim to implement one in the future.

PMID: 16780619 [PubMed - in process]

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Adherence to mental health guidelines by Dutch occupational physicians.

Occup Med (Lond). 2006 Oct;56(7):461-8

Authors: Rebergen D, Hoenen J, Heinemans A, Bruinvels D, Bakker A, van Mechelen W

BACKGROUND: In 2000, the Dutch Association of Occupational Physicians published a national guideline for the management of employees with mental health problems. OBJECTIVES: To examine predictors of adherence to this guideline by Dutch occupational physicians (OPs). METHODS: Using the Theory of Planned Behaviour, a questionnaire was developed about self-reported guideline adherence of OPs and possible predictors of this behaviour. A total of 165 OPs were approached to complete the questionnaire and registration forms of first consultations of workers with mental health problems. Performance indicators based on the guideline were developed to calculate performance rates of guideline adherence by OPs. RESULTS: Eighty of 165 (48%) OPs approached completed the questionnaire. Fifty-six OPs returned one or more registration forms, totalling 344 consultations. On a five-point Likert scale, ranging from never (1) to always (5), the mean score on self-reported guideline adherence was 2.35, compared to a mean score of 4.06 on the intention to comply with the guideline. The mean performance rate of OPs ranging from 0 to 2 was 1.27 on diagnosis and 0.60 on guidance. No relation was found between self-reported guideline adherence and performance rates. Self-reported guideline adherence correlated significantly with perceived behaviour control (r = 0.48, P

PMID: 16782772 [PubMed - in process]

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