Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group.

Circulation. 2007 Apr 19;

Authors: Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT

BACKGROUND: The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for the prevention of infective endocarditis that were last published in 1997. METHODS AND RESULTS: A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis, with liaison members representing the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. The writing group reviewed input from national and international experts on infective endocarditis. The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis, in vitro susceptibility data of the most common microorganisms that cause infective endocarditis, results of prophylactic studies in animal models of experimental endocarditis, and retrospective and prospective studies of prevention of infective endocarditis. MEDLINE database searches from 1950 to 2006 were done for English-language papers using the following search terms: endocarditis, infective endocarditis, prophylaxis, prevention, antibiotic, antimicrobial, pathogens, organisms, dental, gastrointestinal, genitourinary, streptococcus, enterococcus, staphylococcus, respiratory, dental surgery, pathogenesis, vaccine, immunization, and bacteremia. The reference lists of the identified papers were also searched. We also searched the AHA online library. The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used. The paper was subsequently reviewed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee. CONCLUSIONS: The major changes in the updated recommendations include the following: (1) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100% effective. (2) Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. (3) For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. (4) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis. (5) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure. These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations.

PMID: 17446442 [PubMed - as supplied by publisher]

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Drinking guidelines for exercise: What evidence is there that athletes should drink “as much as tolerable”, “to replace the weight lost during exercise” or “ad libitum”?

J Sports Sci. 2007 May;25(7):781-96

Authors: Noakes TD

The most recent (1996) drinking guidelines of the American College of Sports Medicine (ACSM) propose that athletes should drink “as much as tolerable” during exercise. Since some individuals can tolerate rates of free water ingestion that exceed their rates of free water loss during exercise, this advice has caused some to overdrink leading to water retention, weight gain and, in a few, death from exercise-associated hyponatraemic encephalopathy. The new drinking guidelines of the International Olympic Committee (IOC), recently re-published in this Journal, continue to argue that athletes must drink enough to replace all their weight lost during exercise and to ingest sodium chloride since sodium is “the electrolyte most critical to performance and health”. In this rebuttal to that Consensus Document, I argue that these new guidelines, like their predecessors, lack an adequate, scientifically proven evidence base. Nor have they been properly evaluated in appropriately controlled, randomized, prospective clinical trials. In particular, these new guidelines provide erroneous recommendations on five topics. If novel universal guidelines for fluid ingestion during exercise are to be promulgated by important international bodies including the IOC, they should first be properly evaluated in appropriately controlled, randomized, prospective clinical trials conducted under environmental and other conditions that match those found in “out-of-doors” exercise. This, and the potential influence of commercial interests on scientific independence and objectivity, are the two most important lessons to be learned from the premature adoption of those 1996 ACSM drinking guidelines that are not evidence-based. These concerns need to be addressed before the novel IOC guidelines are accepted uncritically. Otherwise the predictable consequences of the premature adoption of the 1996 ACSM guidelines will be repeated.

PMID: 17454546 [PubMed - in process]

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Dose of Hypertension More Accurately Identifies Patients with Stroke at Risk for Adverse Neurologic Outcome Than AHA Guidelines.

Acad Emerg Med. 2007 May;14(5 Suppl 1):S153-4

Authors: Barton C, Hemphill J

PMID: 17463627 [PubMed - in process]

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Impact of New Resuscitation Guidelines on Out-of-hospital Cardiac Arrest Survival.

Acad Emerg Med. 2007 May;14(5 Suppl 1):S157-8

Authors: Fales W, Farrell R

PMID: 17463638 [PubMed - in process]

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New CDC Guidelines for HIV Testing: Emergency Medicine Resident Attitudes and Perceptions before and after an Educational Program and Testing Implementation.

Acad Emerg Med. 2007 May;14(5 Suppl 1):S176

Authors: Hsieh YH, Jung J, Moring-Parris D, Kelen G, Rothman R

PMID: 17463694 [PubMed - in process]

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Reduction of Physical Restraint Use in Emergency Behavioral Health Patients after Logistic Modification of Infrastructure and Implementation of Evidence-based Care Guidelines.

Acad Emerg Med. 2007 May;14(5 Suppl 1):S203-4

Authors: Yeich T, Baltarowich L, Farrer J, Finn M, Sankey S, Tomlanovich M

PMID: 17463775 [PubMed - in process]

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Pre-formatted Structured Charts Versus Open Charts: A Comparison of Documentation and Adherence to Consensus Guidelines.

Acad Emerg Med. 2007 May;14(5 Suppl 1):S209-10

Authors: Sehnert L, Castro-Marin F, Little C, Lowenstein S

PMID: 17463792 [PubMed - in process]

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Emergency department patients with community acquired pneumonia: effect of a change in pneumonia definition by centers for medicare and medicaid services on compliance with guidelines for time to antibiotic administration.

Acad Emerg Med. 2007 May;14(5 Suppl 1):S56

Authors: Katz B, Burton J, Lin C, McErlean M

PMID: 17463921 [PubMed - in process]

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Association Between Implementation of Clinical Practice Guidelines and Outcome for Traumatic Brain Injury.

World J Surg. 2007 Apr 27;

Authors: Keris V, Lavendelis E, Macane I

BACKGROUND: Traumatic brain injury (TBI) is the leading cause of death in the population under 40 years of age in Western countries, and the same was true for Latvia in 1999. This indicated a strong need to improve the management of TBI. The Latvian Society of Neurosurgeons in collaboration with related societies created a dedicated working group, and the Guidelines for Medical Management of TBI in Latvia (Guidelines) were developed in 2001. This study aimed to assess the association between implementation of the Guidelines and the outcome of TBI patients. METHODS: The Guidelines were printed and distributed to relevant clinical units and teaching institutions. To assess the impact of the Guidelines on the outcome of TBI, Latvian medical statistics were researched. All patients admitted to emergency departments and registered as either discharged or dead with a diagnosis of head trauma from 1998 to 2004 were included in a retrospective survey. The primary endpoint accepted for analysis was the hospital case fatality rate (HCFR). RESULTS: The survey included 73,062 consecutive cases. The annual incidence rate of TBI admissions was stable during the period 1998 to 2004 (range 41.5-46.0/10,000), and the incidence of moderate and severe TBI (range 7.2-8.7/10,000) showed no significant trends. There was a reduction of HCFR from 3.7% during 1998-2000 to 2.6% during 2002-2004 (relative risk 0.72; 95% confidence interval 0.67-0.76; p = 0.03). CONCLUSION: Implementation of the Guidelines was associated with a statistically significant decrease of HCFR in TBI patients.

PMID: 17464541 [PubMed - as supplied by publisher]

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Assessing the impact of media guidelines for reporting on suicides in Austria: interrupted time series analysis.

Aust N Z J Psychiatry. 2007 May;41(5):419-28

Authors: Niederkrotenthaler T, Sonneck G

Objective: Media guidelines for reporting on suicides are a widely used means of preventing imitative suicides, but scientific accounts of their impact on suicide numbers are sparse. This report provides an evaluation of the Austrian guidelines that were introduced in 1987 as a natural experiment. Methods: The impact of the guidelines was tested by applying an autoregressive integrated moving average (ARIMA) model and a linear regression model. In addition to a nationwide evaluation, Austria was divided into three areas according to regional differences in coverage rates of the collaborating newspapers and the impact of the intervention was tested for each area separately. Main outcome measures were the overall annual suicide numbers, and the numbers of Viennese subway suicides that were exceptionally newsworthy for the mass media. In order to test intermediate impacts, also quantitative and qualitative changes in media reporting after the introduction of the guidelines were analysed. Results: There was some evidence of a nationwide impact of the guidelines, calculated as a significant reduction of 81 suicides (95% confidence interval: -149 to -13; t = -2.32, df = 54, p

PMID: 17464734 [PubMed - in process]

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