Follow up of patients with colorectal polyps: are the BSG guidelines being adhered to?

Colorectal Dis. 2007 Mar;9(3):203-6

Authors: Pickard M, Dewar EP, Kapadia RC, Khan RB, Hutchinson IF, Nejim A

Objective The publication of the BSG guidelines in 2002 provided a framework for the follow up of patients with colorectal polyps. The aim of the present study was to determine whether they had, or were being correctly adhered to in a moderately sized District General Hospital. Method A total of 598 patients were on the waiting list for colonoscopy at Airedale General Hospital (AGH) in February 2005. Of these, 203 were being followed up as a result of the previous finding of a polyp. Results Only 14.8% of patients had been or were being followed up according to the BSG guidelines. The majority of the 85.2% of patients who did not comply with follow up did so as a result of over investigation. Seventy-eight per cent of the low-risk group and 55% of the intermediate-risk group had been colonoscoped, or were waiting to have colonoscopy, too soon or too frequently according to the BSG guidelines. Twenty-four patients with hyperplastic polyps were being followed up incorrectly, as were 17 patients discovered to have a polyp pathology on flexible sigmoidoscopy. It was established that 131 extra colonoscopies had been, or were planned to be performed unnecessarily. Conclusion These data have major implications with regard to patient safety, service provision and cost to the NHS.

PMID: 17298616 [PubMed - in process]

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Allocation of substance use disorder patients to appropriate levels of care: feasibility of matching guidelines in routine practice in Dutch treatment centres.

Addiction. 2007 Mar;102(3):466-74

Authors: Merkx MJ, Schippers GM, Koeter MJ, Vuijk PJ, Oudejans S, de Vries CC, van den Brink W

Aims To examine the feasibility of implementing evidence-based guidelines for patient-treatment-matching to levels of care in two Dutch substance abuse treatment centres. Design Multi-centre observational follow-up study. Setting Two large substance abuse treatment centres (SATCs). Participants All 4394 referrals to the two SATCs in 2003. Measurements Baseline patient characteristics needed for treatment allocation according to protocol, treatment allocation according to matching protocol, treatment allocation according to actual level of care (LOC) entered. Analysis Comparison of recommended and actual LOC entered. Evaluation of reasons for observed differences between recommended and actual LOC entered. Findings Data needed for treatment allocation according to protocol were available for 2269 (51.6%) patients. Data needed for evaluation of actual LOC entered were available for 1765 (40.2%) patients. Of these patients, 1089 (60.8%) were allocated according to protocol: 48.4% based on the guideline algorithm and 12.4% based on clinically justified deviations from this algorithm. The main reason for deviation was a different appraisal of addiction severity, made by the intake counsellor compared to the protocol. Conclusion The feasibility of guideline-based treatment allocation is seriously limited due to inadequate data collection of patient characteristics and suboptimal guideline-based treatment allocation. As a consequence, only 24.4% of the patients could be evaluated as being matched properly to the treatment planned. The results indicate several barriers which limit the adequate implementation of patient-treatment-matching guidelines: problems in the infrastructure of data collection and storage and the inertia of intake staff who did not adhere to the guidelines for assessment and matching.

PMID: 17298655 [PubMed - in process]

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General practitioner diagnosis and management of acute knee injuries: summary of an evidence-based guideline.

N Z Med J. 2007;120(1249):U2419

Authors: Robb G, Reid D, Arroll B, Jackson RT, Goodyear-Smith F

AIMS: To summarise evidence and key recommendations for general practitioner diagnosis and management of acute soft-tissue knee injuries, based on the New Zealand guideline. METHODS: A multidisciplinary team developed the guideline by critically appraising and grading retrieved literature using the Graphic Appraisal Tools for Epidemiology, Clinical decision rules and the Scottish Intercollegiate Guideline Network. Recommendations were derived from resulting evidence tables. RESULTS: For both diagnosis and management there is a paucity of good evidence to support diagnosis and treatment of internal derangements of the knee, hence some aspects of the guideline are guideline team consensus. Good evidence supports the use of the Ottawa Knee rules to guide decisions about the use of X-ray, and the Lachman test in diagnosing anterior cruciate ligament (ACL) tears. Evidence supports inclusion of proprioceptive training in rehabilitation programmes following ACL reconstruction and in people with ACL-deficient knees. There is good evidence that ultrasound is of little benefit, and there is no evidence that physiotherapy be routinely advocated following meniscectomy. CONCLUSION: This guideline provides an evidence-based framework for diagnosis and management of internal derangements of the knee following acute injury. Moreover, its development highlights significant gaps in the evidence base and identifies priorities for new research.

PMID: 17308556 [PubMed - indexed for MEDLINE]

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Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update.

Circulation. 2007 Feb 19;

Authors: Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, Ganiats TG, Gomes AS, Gornik HL, Gracia C, Gulati M, Haan CK, Judelson DR, Keenan N, Kelepouris E, Michos ED, Newby LK, Oparil S, Ouyang P, Oz MC, Petitti D, Pinn VW, Redberg RF, Scott R, Sherif K, Smith SC, Sopko G, Steinhorn RH, Stone NJ, Taubert KA, Todd BA, Urbina E, Wenger NK

PMID: 17309915 [PubMed - as supplied by publisher]

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The Implementation of Guidelines and Prognosis among Patients with Acute Coronary Syndromes Is Influenced by Physicians’ Perception of Antecedent Physical and Cognitive Status.

Cardiology. 2007 Feb 19;107(4):422-428

Authors: Porter A, Iakobishvili Z, Dictiar R, Behar S, Hod H, Gottlieb S, Hammerman H, Zahger D, Hasdai D

Background/Aims: Physicians’ perception of antecedent physical/cognitive status may account for the suboptimal implementation of acute coronary syndrome (ACS) guidelines. Methods: In an ACS survey of all cardiac wards, physicians’ perception of antecedent physical/cognitive status was prospectively recorded and categorized as either normal, mildly impaired or significantly impaired. We examined the impact of antecedent status on the use of evidence-based medications and procedures and on mortality. Results: Of the 2,021 patients, 1,025 (51%) had ST elevation. Impaired antecedent physical/cognitive status was diagnosed in 417 patients (20.6%), more commonly among non-ST-elevation patients (26.2 vs. 15.2%). Patients with impaired physical/cognitive status, with or without ST elevation, had significantly worse baseline demographic and clinical characteristics. They less often received aspirin, clopidogrel, platelet glycoprotein IIb/IIIa receptor antagonists, statins and beta-adrenergic blockers, and significantly less often underwent in-hospital catheterization and revascularization. Reperfusion treatment was given significantly less frequently to ST elevation patients with impaired status (63.0% for normal vs. 50.8% and 33.3% for mildly and significantly impaired status, respectively; p = 0.001). After adjustment for differences in baseline characteristics, impaired antecedent status remained independently associated with lower use of these therapies and higher mortality rates. Conclusions: ACS guideline implementation is significantly influenced by physicians’ perception of antecedent physical/cognitive status, and thus is a crucial parameter for understanding ACS management and outcomes. Copyright (c) 2007 S. Karger AG, Basel.

PMID: 17310116 [PubMed - as supplied by publisher]

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Management of recurrent miscarriage: evaluating the impact of a guideline.

Hum Reprod. 2007 Feb 22;

Authors: Franssen MT, Korevaar JC, van der Veen F, Boer K, Leschot NJ, Goddijn M

BACKGROUND Little is known on the actual diagnostic and therapeutic management of recurrent miscarriage and the impact of introducing guidelines on this topic. The objective of this study was to evaluate any changes in the management of recurrent miscarriage among Dutch gynaecologists after the introduction of the Dutch guideline ‘Recurrent Miscarriage’ in 1999. METHODS Questionnaires were sent to all practices for obstetrics and gynaecology in the Netherlands. Data concerned definition, diagnosis and treatment of recurrent miscarriage. Results were compared with a similar study conducted before the introduction of the guideline and with the recommendations in the guideline. RESULTS The response rate was 83%. Regarding gestational age, only 3% of the respondents used the definition as advised in the guideline. After the introduction of the guideline, thrombophilia factors were tested more frequently, anticoagulants were prescribed more frequently and more respondents reported to correct uterine malformations. Therapies not described in the guideline, e.g. donor insemination and oocyte donation, were still applied. CONCLUSIONS The adherence to the Dutch guideline ‘Recurrent Miscarriage’ was rather poor, presumably due to guideline-related as well as physician-related barriers. Too many diagnostic tests and ineffective therapeutic interventions were performed. This study demonstrates the importance of appropriate implementation and revision.

PMID: 17317720 [PubMed - as supplied by publisher]

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Guidelines for assessing immunocompetency in clinical trials for autoimmune diseases.

Clin Immunol. 2007 Feb 26;

Authors: Looney RJ, Diamond B, Holers VM, Levesque MC, Moreland L, Nahm MH, St Clair EW

Clinical trials testing the safety and efficacy of immunosuppressive agents for the treatment of autoimmune diseases should also be designed to evaluate immunocompetency. The most clinically relevant outcome for assessing immunocompetency is the infection rate. Therefore, a systematic approach to screening, monitoring, and reporting infections, modeled after the recommendations of the American Society of Transplantation, is presented. However, because the baseline infection rate in most autoimmune diseases is low, additional tests for immunocompetency should be considered. Evaluation of vaccine responses, an alternative clinically relevant approach, may be particularly useful. Other adjunctive approaches to evaluation of immunocompetency are discussed including immunization with non-vaccine neoantigens, surveillance of chronic viral infections, in vivo or in vitro assessment of cellular immunity, and analysis of innate immunity. Banking genetic material to allow genotyping should be considered particularly if a central repository for samples from different trials can be established.

PMID: 17329169 [PubMed - as supplied by publisher]

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Adherence to College biomerty guidelines.

Eye. 2007 Mar 2;

Authors: Ali N

PMID: 17332763 [PubMed - as supplied by publisher]

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Adherence to college biometry guidelines.

Eye. 2007 Mar 2;

Authors: Johnston RL

PMID: 17332764 [PubMed - as supplied by publisher]

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Incidence of late vitamin K deficiency bleeding in newborns in the Netherlands in 2005: evaluation of the current guideline.

Eur J Pediatr. 2007 Mar 1;

Authors: Ijland MM, Pereira RR, Cornelissen EA

Vitamin K prophylaxis is recommended to prevent the hazard of haemorrhage caused by vitamin K deficiency in newborns. The present Dutch guideline recommends 1 mg of vitamin K(1) orally at birth, followed by a daily dose of 25 mug of vitamin K(1) from 1 to 13 weeks of age for breastfed infants. Since the introduction of this prophylaxis, the incidence of vitamin K deficiency bleeding (VKDB) has decreased; however, late VKDB is still reported. From 1 January to 31 December 2005, a nationwide active surveillance was performed by the Netherlands Paediatric Surveillance Unit (NSCK) to study the current incidence and aetiology of late VKDB in infants. Six cases could be validated as late VKDB: all were breastfed, one fatal idiopathic intracranial haemorrhage at the age of 5 weeks and five bleedings secondary to an underlying cholestatic liver disease between the age of 3 and 7 weeks. The total incidence of late VKDB and idiopathic late VKDB was calculated to be 3.2 (95% CI: 1.2-6.9) and 0.5 (95% CI: 0-2.9) per 100,000 live births, respectively. With the current Dutch guideline, idiopathic late VKDB is rare but late VKDB secondary to cholestasis still occurs in breastfed infants. Doubling the daily dose of vitamin K(1) to 50 mug, as is comparable to formula-feeding, may possibly prevent VKDB in this group. Further research, however, is needed to prove this hypothesis.

PMID: 17333271 [PubMed - as supplied by publisher]

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