Related ArticlesImproving the use of research evidence in guideline development: introduction.

Health Res Policy Syst. 2006;4:12

Authors: Oxman AD, Fretheim A, Schünemann HJ,

ABSTRACT: In 2005 the World Health Organisation (WHO) asked its Advisory Committee on Health Research (ACHR) for advice on ways in which WHO can improve the use of research evidence in the development of recommendations, including guidelines and policies. The ACHR established the Subcommittee on the Use of Research Evidence (SURE) to collect background documentation and consult widely among WHO staff, international experts and end users of WHO recommendations to inform its advice to WHO. We have prepared a series of reviews of methods that are used in the development of guidelines as part of this background documentation. We describe here the background and methods of these reviews, which are being published in Health Research Policy and Systems together with this introduction.

PMID: 17116254 [PubMed - in process]

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Related ArticlesEffectiveness of a chronic kidney disease clinic in achieving K/DOQI guideline targets at initiation of dialysis–a single-centre experience.

Nephrol Dial Transplant. 2006 Nov 24;

Authors: Lee W, Campoy S, Smits G, Vu Tran Z, Chonchol M

BACKGROUND: Limited data exist about the effects of chronic kidney disease (CKD) clinics on quality-of-care indicators in patients before initiation of dialysis. METHODS: A single-centre retrospective chart review study was conducted on all patients who initiated dialysis at the Veterans Affairs Denver Healthcare System between 2000 and 2005. Patients initiating dialysis were evaluated at the start of dialysis and 12 months after dialysis initiation, as a function of care provided by nephrologists in training (renal-hypertension clinic) vs a trained renal nurse practitioner (CKD clinic). RESULTS: Data were available for 77 patients followed in the CKD clinic and 36 in the renal-hypertension clinic. There were no major demographic differences between the cohorts at the time of clinic referral. The length of follow-up before dialysis did not differ significantly between the cohorts (10.7+/-9.8 months for the patients in the CKD clinic cohort and 13.6+/-16.0 months for the patients in the renal-hypertension clinic cohort, P=0.3299). At the initiation of dialysis, patients followed in the CKD clinic had higher haemoglobin (11.6+/-1.5 vs 10.8+/-1.7 g/dl, P=0.0239) and serum albumin (3.4+/-0.5 vs 3.0+/-0.7 g/dl, P=0.0020) concentrations. More of the CKD clinic patients had a functioning permanent vascular access (P

PMID: 17127695 [PubMed - as supplied by publisher]

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Related ArticlesAdherence of Irish general practitioners to European guidelines for acute low back pain: A prospective pilot study.

Eur J Pain. 2006 Nov 22;

Authors: Fullen BM, Maher T, Bury G, Tynan A, Daly LE, Hurley DA

There are no national low back pain (LBP) clinical guidelines in Ireland, and neither the level of adherence of General Practitioners (GPs) to the European guidelines, nor the cost of LBP to the patient and the state, have been investigated. A prospective pilot study was conducted on 54 consenting patients (18M, 36F: mean age (SD): 40.5 (14.3) years) with a new episode of acute LBP (

PMID: 17126046 [PubMed - as supplied by publisher]

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Related ArticlesNurses’ knowledge and application of evidence-based guidelines for preventing ventilator-associated pneumonia.

Minerva Anestesiol. 2006 Nov 20;

Authors: Biancofiore G, Barsotti E, Catalani V, Landi A, Bindi L, Urbani L, Desimone P, Stefanini A, Sansevero A, Filipponi F

AIM: The aim of the study was to evaluate the nurses’ knowledge and application of evidence-based guidelines that foresee non-pharmacological actions for preventing ventilation-associated pneumonia (VAP) by highlighting the causes that may make their use difficult. METHODS: Experimental design: descriptive study. Setting and participants: 106 nurses working in the ICUs of a major Italian hospital of national importance. Intervention: administration of a questionnaire listing 21 non-pharmacological strategies considered the most useful in the literature. RESULTS: Eighty-four nurses responded to the questionnaire. Only 19 (22.6%) declared that their knowledge of VAP and the strategies used to prevent it was satisfactory, whereas 46 (54.8%) declared that they were poorly informed; 68 nurses (80.9%) said that they applied at least one of the strategies, and 15 (17.9%) that they applied none. The reasons given for not applying the strategies were: method not foreseen in Department protocols (31.5%), a lack of the necessary resources (14.3%), disagreement with the method (3.2%), high costs (2.6%), the possibility of causing discomfort (1%) or side effects to the patient (0.6%). CONCLUSIONS: In our experience, VAP preventive strategies are widely applied by nurses, but not in a responsible and informed manner. It is important to ensure that nurses receive continuous training and are involved in drawing up and updating Departmental protocols and guidelines for care and behaviour.

PMID: 17115016 [PubMed - as supplied by publisher]

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Related ArticlesEvidence-based guidelines for using the Short Form 36 in cervical dystonia.

Mov Disord. 2006 Nov 17;

Authors: Cano SJ, Thompson AJ, Bhatia K, Fitzpatrick R, Warner TT, Hobart JC

We aimed to provide evidence-based guidelines for using the Short Form 36 (SF-36) as an outcome measure in cervical dystonia (CD). To do this, we tested the hypothesized relationships between items, scales, and summary measures of the SF-36 using psychometric analyses in data from a postal survey of 235 people with CD. Although the majority of subscales performed adequately, the Role Physical and Role Emotional subscales had substantial floor and/or ceiling effects. Evidence did not support computing SF-36 Physical and Mental Component Summary scores. We propose guidelines that include the recommendation that these subscale and summary scores should be reported with caution. (c) 2006 Movement Disorder Society.

PMID: 17115394 [PubMed - as supplied by publisher]

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Related ArticlesEstimation of the optimal brachytherapy utilization rate in the treatment of carcinoma of the uterine cervix: review of clinical practice guidelines and primary evidence.

Cancer. 2006 Nov 15;

Authors: Thompson S, Delaney G, Gabriel GS, Jacob S, Das P, Barton M

BACKGROUND.: Brachytherapy (BT) is an integral part of cervical carcinoma treatment. There have been no attempts to estimate the optimal proportion of new cervical carcinoma cases that should be treated with BT, that is, the optimal rate of brachytherapy utilization (BTU). METHODS.: Evidence-based guidelines and primary evidence were used to construct a BTU tree for carcinoma of the uterine cervix. Searches were performed of the epidemiological literature to ascertain the proportion of patients who fulfilled criteria for BT. The robustness of the model was tested by sensitivity analyses and by peer review. A patterns of care study of BT in New South Wales for 2003 was conducted, and actual BTU for cervical carcinoma determined. The differences between optimal and actual rates of BTU were assessed. RESULTS.: The optimal cervical carcinoma BTU was 49% (range, 42% to 50%). In New South Wales in 2003, actual BTU was only 30% of 256 cervical carcinoma patients. The major discrepancy was for FIGO stage IB-IIA disease, where there was an underutilization of BT, estimated to be 15% actual use compared with 47% optimal use. In Surveillence, Epidemiology, and End Results (SEER) areas, there was underutilization for stage IB-IIA (22% actual BTU versus 47% optimal BTU) and for stage IIB-IVA (54% actual BTU versus 100% optimal BTU). CONCLUSIONS.: BT for cervical carcinoma is underutilized in New South Wales and in SEER areas. The authors’ model of optimal BTU can be used as a quality assurance tool to provide an evidence-based benchmark against which actual patterns of practice can be measured. The model can also be used to help determine adequacy of BT resource allocation. Cancer 2006. (c) 2006 American Cancer Society.

PMID: 17109449 [PubMed - as supplied by publisher]

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Related ArticlesFailure to implement hospital antimicrobial prescribing guidelines: experience in another UK academic centre.

J Antimicrob Chemother. 2006 Nov 9;

Authors: Mahungu J, Fajemisin O, Bowler IC

PMID: 17095525 [PubMed - as supplied by publisher]

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Related ArticlesMild therapeutic hypothermia after cardiac arrest-A nationwide survey on the implementation of the ILCOR guidelines in German intensive care units.

Resuscitation. 2006 Nov 9;

Authors: Wolfrum S, Radke PW, Pischon T, Willich SN, Schunkert H, Kurowski V

AIM: To investigate the implementation of mild therapeutic hypothermia (MTH) after cardiac arrest into clinical practice. METHODS AND RESULTS: A structured evaluation questionnaire was sent to all German hospitals registered to have ICUs; 58% completed the survey. A total of 93 ICUs (24%) reported to use MTH. Of those, 93% started MTH in patients after out-of-hospital resuscitation with observed ventricular fibrillation and 72% when other initial rhythms were observed. Only a minority of ICUs initiate MTH in patients after cardiac arrest with cardiogenic shock (28%), whereas 48% regarded cardiogenic shock as a contra-indication for MTH. On average, target temperature was 33.1+/-0.6 degrees C and duration of cooling 22.9+/-4.9h. Many centres used economically priced cold packs (82%) and cold infusions (80%) for cooling. The majority of the ICUs considered infection, hypotension and bleeding as relevant complications of hypothermia which was of therapeutic relevance in less than 25% of the cases. CONCLUSIONS: MTH is underused in German ICUs. Centres which use MTH widely follow the recommendations of ILCOR with respect to the indication and timing of cooling. In hospitals that use MTH the technique is considered to be safe and inexpensive. More efforts are needed to promote this therapeutic option and hypothermia since MTH has now been included into European advanced cardiovascular life support protocols.

PMID: 17097795 [PubMed - as supplied by publisher]

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Related ArticlesEvidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology.

J Psychopharmacol. 2006 Nov 8;

Authors: Nutt DJ, Fone K, Asherson P, Bramble D, Hill P, Matthews K, Morris KA, Santosh P, Sonuga-Barke E, Taylor E, Weiss M, Young S

Attention-deficit/hyperactivity disorder (ADHD) is an established diagnosis in children, associated with a large body of evidence on the benefits of treatment. Adolescents with ADHD are now leaving children’s services often with no readily identifiable adult service to support them, which presents problems as local pharmacy regulations often preclude the prescription of stimulant drugs by general practitioners (GPs). In addition, adults with ADHD symptoms are now starting to present to primary care and psychiatry services requesting assessment and treatment. For these reasons, the British Association for Psychopharmacology (BAP) thought it timely to hold a consensus conference to review the body of evidence on childhood ADHD and the growing literature on ADHD in older age groups. Much of this initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence. We hope that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.

PMID: 17092962 [PubMed - as supplied by publisher]

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The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.

Clin Infect Dis. 2006 Nov 1;43(9):1089-134

Authors: Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB

Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post-Lyme disease syndrome is proposed.

PMID: 17029130 [PubMed - indexed for MEDLINE]

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