Musings on guidelines and evidence: an opposing view.

Perit Dial Int. 2007 Jan-Feb;27(1):35-8

Authors: Suri RS

PMID: 17179506 [PubMed - in process]

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Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures.

Spinal Cord. 2006 Dec 19;

Authors: Steeves JD, Lammertse D, Curt A, Fawcett JW, Tuszynski MH, Ditunno JF, Ellaway PH, Fehlings MG, Guest JD, Kleitman N, Bartlett PF, Blight AR, Dietz V, Dobkin BH, Grossman R, Short D, Nakamura M, Coleman WP, Gaviria M, Privat A

An international panel reviewed the methodology for clinical trials of spinal cord injury (SCI), and provided recommendations for the valid conduct of future trials. This is the second of four papers. It examines clinical trial end points that have been used previously, reviews alternative outcome tools and identifies unmet needs for demonstrating the efficacy of an experimental intervention after SCI. The panel focused on outcome measures that are relevant to clinical trials of experimental cell-based and pharmaceutical drug treatments. Outcome measures are of three main classes: (1) those that provide an anatomical or neurological assessment for the connectivity of the spinal cord, (2) those that categorize a subject’s functional ability to engage in activities of daily living, and (3) those that measure an individual’s quality of life (QoL). The American Spinal Injury Association impairment scale forms the standard basis for measuring neurologic outcomes. Various electrophysiological measures and imaging tools are in development, which may provide more precise information on functional changes following treatment and/or the therapeutic action of experimental agents. When compared to appropriate controls, an improved functional outcome, in response to an experimental treatment, is the necessary goal of a clinical trial program. Several new functional outcome tools are being developed for measuring an individual’s ability to engage in activities of daily living. Such clinical end points will need to be incorporated into Phase 2 and Phase 3 trials. QoL measures often do not correlate tightly with the above outcome tools, but may need to form part of Phase 3 trial measures.Spinal Cord advance online publication, 19 December 2006; doi:10.1038/sj.sc.3102008.

PMID: 17179972 [PubMed - as supplied by publisher]

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Impact of Patient- and Disease-Specific Factors on SLNB in Breast Cancer Patients. Are Current Guidelines Justified?

World J Surg. 2007 Feb;31(2):267-75

Authors: Bembenek A, Fischer J, Albrecht H, Kemnitz E, Gretschel S, Schneider U, Dresel S, Schlag PM

BACKGROUND: The evidence on which to base guidelines for sentinel lymph node biopsy (SLNB) in breast cancer is still limited. In order to facilitate the further implementation of renewed guidelines, we evaluated patient- and disease-specific factors for their impact on the results of SLNB. MATERIALS AND METHODS: Prospective data acquisition from patients undergoing surgery for primary invasive breast cancer was performed. All patients underwent SLNB using the radiocolloid or the combined technique. The association of patient- and disease-specific factors to detection rate and false-negative rate was calculated using univariate and multivariate analyses (P

PMID: 17180478 [PubMed - in process]

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The impacts and outcomes of implementing head injury guidelines: clinical experience in Thailand.

Emerg Med J. 2007 Jan;24(1):25-30

Authors: Ratanalert S, Kornsilp T, Chintragoolpradub N, Kongchoochouy S

OBJECTIVE: To describe the impact of implementing clinical practice guidelines (CPG) for head injury in a trauma referral system in Songkla province, Thailand. METHODS: The CPG was developed by a local multidisciplinary team and implemented using multi-faceted methods. The outcome of patients with head injury from three community hospitals and a university hospital (Songklanagarind Hospital) was reported in terms of “talk and deteriorate” patients and a “poor” outcome for patients with severe head injury. Changes to clinical practice were observed where the guidelines were implemented. RESULTS: 1000 patients with head injury were enrolled from 1st August 2005 to 15th January 2006. The incidence of “talk and deteriorate” patients was 10.5% and a poor outcome was noted in 35.5% of patients with severe head injury, similar to the results of a previous study in Songklanagarind Hospital (p>0.05). Following implementation of the guidelines, 19.8% of patients underwent CT scanning with similar outcomes for alert patients with and without basal skull fracture (p>0.05). The clinician-nurse relationship also improved and there was closer collaboration between hospitals. Short observation in community hospitals for repeat neurological examination may be an appropriate strategy for management of some patients with minor head injury. CONCLUSIONS: Local ownership, an appropriate implementation strategy and working as a multidisciplinary team are key factors for success in implementing the CPG. Basal skull fracture may not be an absolute criterion for CT imaging of the head. Further initiatives will be developed in response to the incidence of “talk and deteriorate” patients.

PMID: 17183038 [PubMed - in process]

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European Best Practice Guidelines for Peritoneal Dialysis acknowledged by ISN.

Nat Clin Pract Nephrol. 2007 Jan;3(1):6-7

Authors: Abboud O, Barsoum R, Berthoux F, Field M, Johnson R, Lin S, Massari P

PMID: 17183252 [PubMed - in process]

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Practice parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.

Neurology. 2006 Dec 26;67(12):2266; author reply 2266

Authors: Montgomery EB

PMID: 17190966 [PubMed - indexed for MEDLINE]

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Lack of effect of guideline changes on hypertension control for patients with diabetes in the U.S., 1995-2005.

Diabetes Care. 2007 Jan;30(1):49-52

Authors: Wang YR

OBJECTIVE: To study the effect of new Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines on hypertension control for patients with diabetes in the U.S. using patients without diabetes as the control group for the time trend. RESEARCH DESIGN AND METHODS: The JNC VI and VII guidelines, published in 1997 and 2003, set more aggressive goal blood pressure for patients with diabetes. Data from the National Disease and Therapeutic Index, a nationally representative survey of outpatient visits in the U.S., was used to compare the difference in hypertension control (blood pressure

PMID: 17192332 [PubMed - in process]

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Nurses’ implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention.

Am J Crit Care. 2007 Jan;16(1):28-36; discussion 37; quiz 38

Authors: Cason CL, Tyner T, Saunders S, Broome L,

BACKGROUND: Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. OBJECTIVE: To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. METHODS: Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. RESULTS: Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. CONCLUSIONS: The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

PMID: 17192524 [PubMed - in process]

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Health care quality and outcome guidelines for nursing of children and families: implications for pediatric nurse practitioner practice, research, and policy.

J Pediatr Health Care. 2007 Jan-Feb;21(1):64-6

Authors: Betz CL, Cowell JM, Craft-Rosenberg MJ, Krajicek MJ, Lobo ML

PMID: 17198903 [PubMed - in process]

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Evidence behind the WHO Guidelines: Hospital Care for Children * What are the Clinical Indicators of PCP?

J Trop Pediatr. 2007 Feb;53(1):4-7

Authors: Wijesingha S, Graham S

PMID: 17202153 [PubMed - in process]

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