Comments from the Developmental Neurotoxicology Committee of the Japanese Teratology Society on the OECD Guideline for the Testing of Chemicals, Proposal for a New Guideline 426, Developmental Neurotoxicity Study, Draft Document (October 2006 version), and on the Draft Document of the Retrospective Performance Assessment of the Draft Test Guideline 426 on Developmental Neurotoxicity.

Congenit Anom (Kyoto). 2007 Jun;47(2):74-6

Authors: Ema M, Fukui Y, Aoyama H, Fujiwara M, Fuji J, Inouye M, Iwase T, Kihara T, Oi A, Otani H, Shinomiya M, Sugioka K, Yamano T, Yamashita KH, Tanimura T

In October 2006, a new revision of the draft guideline (OECD Guideline for the Testing of Chemicals, Proposal for a New Guideline 426. Developmental Neurotoxicity Study) and Draft Document of the Retrospective Performance Assessment (RPA) of the Draft Test Guideline 426 on Developmental Neurotoxicity were distributed following incorporation of the results of the Expert Consultation Meeting in Tokyo on May 24-26, 2005. The draft guideline consists of 50 paragraphs and an appendix with 102 references; and the draft RPA consists of 37 paragraphs with 109 references. National coordinators were requested to arrange for national expert reviews of these draft documents in their member countries. Members of the Developmental Neurotoxicology (DNT) Committee of the Japanese Teratology Society (JTS) reviewed, discussed, and commented on the draft Test Guideline Proposal. The DNT Committee of the JTS also commented on the draft document of the RPA. These comments were sent to the OECD Secretariat. The DNT Committee of the JTS expects the comments to be useful for the finalization of these draft documents.

PMID: 17504392 [PubMed - in process]

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The development and peer review of evidence-based guidelines to support midwifery led care in labour.

Midwifery. 2007 May 16;

Authors: Spiby H, Munro J

OBJECTIVE: to describe the development and peer review process for the third edition of evidence-based guidelines to support the provision of midwifery led care in labour. METHODS: the process of guideline development including identifying aspects of care for inclusion in the guidelines, the literature search strategy, bibliographic databases used, types of literature reviewed and rationale for inclusion are detailed. The process of formulating recommendations for practice is described. The peer review process, involving the principal stakeholders in the guidelines (midwives and representatives of maternity service users), the appraisal instrument used and issues identified during peer review are included. The third edition of the guidelines was commissioned in 2003 and completed during 2004. DISCUSSION: the development of the evidence-based guidelines is discussed in the context of contemporary debate related to guideline development and evidence-based practice including issues related to the nature and hierarchy of evidence, stakeholder involvement and sociological discourses of evidence-based medicine.

PMID: 17512101 [PubMed - as supplied by publisher]

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Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.

Circulation. 2007 May 22;115(20):e478-534

Authors: Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF, , , , ,

PURPOSE: Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. METHODS: Members of the panel were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council’s Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years. RESULTS: Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.

PMID: 17515473 [PubMed]

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Evidence behind the WHO guidelines: Hospital Care for Children: What are appropriate methods of urine collection in UTI?

J Trop Pediatr. 2007 May 21;

Authors: Long E, Vince J

PMID: 17517815 [PubMed - as supplied by publisher]

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Evidence behind the WHO Guidelines: Hospital Care for Children: What is the Appropriate Empiric Antibiotic Therapy in Uncomplicated Urinary Tract Infections in Children in Developing Countries?

J Trop Pediatr. 2007 Jun;53(3):150-2

Authors: Wolff O, Maclennan C

PMID: 17517816 [PubMed - in process]

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Adherence to physiotherapy clinical guideline acute ankle injury and determinants of adherence: a cohort study.

BMC Musculoskelet Disord. 2007;8:45

Authors: van der Wees PJ, Hendriks EJ, Jansen MJ, van Beers H, de Bie RA, Dekker J

BACKGROUND: Clinical guidelines are considered important instruments to improve quality in health care. In physiotherapy, insight in adherence to guidelines is limited. Knowledge of adherence is important to identify barriers and to enhance implementation. Purpose of this study is to investigate the ability to adherence to recommendations of the guideline Acute ankle injury, and to identify patient characteristics that determine adherence to the guideline. METHODS: Twenty-two physiotherapists collected data of 174 patients in a prospective cohort study, in which the course of treatment was systematically registered. Indicators were used to investigate adherence to recommendations. Patient characteristics were used to identify prognostic factors that may determine adherence to the guideline. Correlation between patient characteristics and adherence to outcome-indicators (treatment sessions, functioning of patient, accomplished goals) was calculated using univariate logistic regression. To calculate explained variance of combined patient characteristics, multivariate analysis was performed. RESULTS: Adherence to individual recommendations varied from 71% to 100%. In 99 patients (57%) the physiotherapists showed adherence to all indicators. Adherence to preset maximum of six treatment sessions for patients with severe ankle injury was 81% (132 patients).The odds to receive more than six sessions were statistically significant for three patient characteristics: females (OR:3.89; 95%CI: 1.41-10.72), recurrent sprain (OR: 6.90; 95%CI: 2.34 – 20.37), co-morbidity (OR: 25.92; 95% CI: 6.79 – 98.93). All factors together explained 40% of the variance. Inclusion of physiotherapist characteristics in the regression model showed that work-experience reduced the odds to receive more than six sessions (OR: 0.2; 95%CI: 0.06 – 0.77), and increased explained variance to 45%. CONCLUSION: Adherence to the clinical guideline Acute ankle sprain showed that the guideline is applicable in daily practice. Adherence to the guideline, even in a group of physiotherapists familiar with the guideline, showed possibilities for improvement. The necessity to exceed the expected number of treatment sessions may be explained by co-morbidity and recurrent sprains. It is not clear why female patients were treated with more sessions. Experience of the physiotherapist reduced the number of treatment sessions. Quality indicators may be used for audit and feedback as part of the implementation strategy.

PMID: 17519040 [PubMed - in process]

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Translating evidence-based guidelines into performance measures for venous thromboembolism and acute coronary syndrome.

Am J Health Syst Pharm. 2007 Jun 1;64(11 Suppl 7):S25-9

Authors: Groce JB

PURPOSE: The evolution of evidence-based quality measures in healthcare, specific performance measures that have been developed by various groups for the prevention and treatment of venous thromboembolism (VTE), the objectives and potential benefits of a national quality improvement initiative designed to improve the care of high-risk patients with acute coronary syndrome (ACS), the reporting of performance data to the public to guide consumer choice, and the recent growth in pay-for-performance programs are described. SUMMARY: Efforts to develop evidence-based quality measures began in the mid to late 1990s and have led to the creation of various safe practices, indicators, standards, and quality measures and initiatives. The prevention and treatment of VTE and the management of ACS have been the focus of some of these initiatives. Reporting of data for two surgery-related VTE process measures to the Centers for Medicare and Medicaid Services began January 1, 2007, and two additional measures may be used in the future. The Joint Commission and National Quality Forum have proposed eight core measures for the prevention and care of VTE that could eventually be used in hospital accreditation decisions. A national quality improvement initiative, CRUSADE, provides participating hospitals with feedback about performance in caring for high-risk patients with non-ST-segment elevation ACS. Reporting of performance data to the public facilitates healthcare decision making by consumers. The use of pay-for-performance programs that provide incentives and rewards for meeting quality goals has grown rapidly in recent years. CONCLUSION: The various initiatives under way using evidence-based performance measures to evaluate quality of care for VTE and ACS have the potential to improve patient outcomes.

PMID: 17519443 [PubMed - in process]

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Continuing Education: Improving the quality of care for venous thromboembolism and acute coronary syndrome: Using evidence-based guidelines and performance measures.

Am J Health Syst Pharm. 2007 Jun 1;64(11 Suppl 7):S30-2

Authors:

PMID: 17519444 [PubMed - in process]

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Merkel cell carcinoma: Critical review with guidelines for multidisciplinary management.

Cancer. 2007 May 22;

Authors: Bichakjian CK, Lowe L, Lao CD, Sandler HM, Bradford CR, Johnson TM, Wong SL

Merkel cell carcinoma (MCC) is a relatively rare cutaneous malignancy that occurs predominantly in the older white population. The incidence of MCC appears to have tripled during the past 20 years; an increase that is likely to continue because of the growing number of older Americans. The pathogenesis of MCC remains largely unknown. However, ultraviolet radiation and immunosuppression are likely to play a significant pathogenetic role. Many questions currently remain unanswered regarding the biologic behavior and optimal treatment of MCC. Large, prospective, randomized studies are not available and are unlikely to be performed because of the rarity of the disease. The objective of this review was to provide a comprehensive reference for MCC based on a critical evaluation of the current data. The authors investigated the importance of sentinel lymph node biopsy as a staging tool for MCC to assess the status of the regional lymph node basin and to determine the need for additional therapy to the lymph node basin. In an attempt to standardize prospective data collection with the intention to define prognostic indicators, the authors also present histopathologic profiles for primary MCC and sentinel lymph nodes. The controversies regarding the appropriate surgical approach to primary MCC, the use of adjuvant radiation therapy, and the effectiveness of adjuvant chemotherapy were examined critically. Finally, the authors have provided treatment guidelines based on the available evidence and their multidisciplinary experience. Cancer 2007. (c) 2007 American Cancer Society.

PMID: 17520670 [PubMed - as supplied by publisher]

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Can Evidence-Based Guidelines and Clinical Trials Tell us How to Treat Patients?

Epilepsia. 2007 May 23;

Authors: French JA

PMID: 17521352 [PubMed - as supplied by publisher]

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