Food-based dietary guidelines for infants and children: the South African experience.

Matern Child Nutr. 2007 Oct;3(4):223

Authors: Aggett P, Moran VH

PMID: 17824848 [PubMed - in process]

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The relative effectiveness of practice change interventions in overcoming common barriers to change: a survey of 14 hospitals with experience implementing evidence-based guidelines.

J Eval Clin Pract. 2007 Oct;13(5):709-15

Authors: Simpson F, Doig GS

Aims and objectives Changing practice to reflect current best evidence can be costly and time-consuming. The purpose of this survey was to determine the optimal combination of practice change interventions needed to overcome barriers to practice change commonly encountered in the intensive care unit (ICU). Design A survey instrument delivered by mail with email follow-up reminders. Setting Fourteen hospitals throughout Australia and New Zealand. Subjects Individuals responsible for implementing an evidence-based guideline for nutritional support in the ICU. Survey Practice change interventions were ranked in order of effectiveness and barriers to change were ranked in order of how frequently they were encountered. Results A response rate of 100% was achieved. Interventions traditionally regarded as strong (academic detailing, active reminders) were ranked higher than those traditionally regarded as moderate (audit and feedback), or weak (posters, mouse mats). The high ranks of the site initiation visit (educational outreach, modest) and in-servicing (didactic lectures, weak) were unexpected, as was the relatively low rank of educationally influential, peer-nominated opinion leaders. Four hospitals reported the same doctor-related barrier as ‘most common’ and the remaining 10 hospitals reported three different doctor-related barriers, two nursing-related barriers and three organizational barriers as most common. Conclusions When designing a multifaceted, multi-centre change strategy, the selection of individual practice change interventions should be based on: (1) an assessment of available resources; (2) recognition of the importance of different types of barriers to different sites; (3) the potential for combinations of interventions to have a synergistic effect on practice change, and (4) the potential for combinations of interventions to actually reduce workload.

PMID: 17824862 [PubMed - in process]

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The fracture and osteoporosis outpatient clinic: an effective strategy for improving implementation of an osteoporosis guideline.

J Eval Clin Pract. 2007 Oct;13(5):801-5

Authors: van Helden S, Cauberg E, Geusens P, Winkes B, van der Weijden T, Brink P

Background Clinical screening for osteoporosis in women aged over 50 years following a fracture is advocated by all guidelines on osteoporosis, but such attitude is widely reported to be inadequate. The aim of this study was to evaluate the effect of a strategy comparing referral for a dual-energy X-ray absorptiometry (DXA) scan as part of the osteoporosis guideline by a dedicated osteoporosis nurse with referral in hospitals without the presence of an osteoporosis nurse. Methods We retrospectively compared one reference hospital with five surrounding hospitals in the Netherlands. During a 2-week period, all female patients aged over 50 years who presented with a fracture at the emergency department of the six hospitals were included. Follow-up was minimal 11 weeks. The primary outcome was the referral for DXA measurement. Results In total, 135 patients were included, of whom 33 were seen in the reference hospital and 102 in the surrounding hospitals. In both groups, mean age and fracture location were similar. In the reference hospital, 14 patients qualified for DXA measurement, of whom 10 patients effectively underwent a DXA scan (71%). In the surrounding hospitals, 78 patients qualified for DXA measurement, of whom only three effectively underwent a DXA scan (4%). Taking into account a refusal percentage for DXA of 33% as was found in the reference centre, 47 patients in the surrounding hospitals should have been qualified for DXA measurement. Thus, successful referral in the surrounding hospitals was three out of 47 (6%) patients. The presence of an osteoporosis nurse did have a significant influence on the amount of DXA scans after fractures [RR 11 (95% CI: 3.6-35.1)]. Conclusions This study indicates that referral for DXA is low in surrounding hospitals, and suggests that the presence of an osteoporosis nurse in the reference hospital significantly increased the number of patients receiving adequate osteoporosis screening with DXA measurement after a recent fracture. With this strategy patients who are at risk of osteoporosis are identified effectively, after which treatment can be started, in order to reduce the risk of future fractures.

PMID: 17824875 [PubMed - in process]

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Implementing a hospital guideline on pneumonia: a semi-quantitative review.

Int J Qual Health Care. 2007 Sep 12;

Authors: Cortoos PJ, Simoens S, Peetermans W, Willems L, Laekeman G

BACKGROUND: and objective To quantify the impact of different guideline implementation interventions to improve treatment of community-acquired pneumonia (CAP) in a hospital setting. METHODS: /st> Pubmed, the Cochrane Library, the Cochrane Effective Practice and Organization of Care specialized register, EMBASE and CINAHL. STUDY SELECTION: /st> Hospital-based trials studying the effect of guidelines on compliance with care processes, clinical and/or economic outcomes in the treatment of CAP together with a description of their implementation interventions. Data extraction Two independent reviewers extracted and categorized utilized implementation interventions, assessed intensity of use and calculated changes for process of care variables, clinical and economical outcomes. Correlations between interventions and improvement of outcomes were assessed by means of Spearman’s rho-test and Mann-Whitney U-test. RESULTS: /st> In 27 included studies, educational meetings (21/27) and distribution of written material (14/27) were the two most used interventions. Most individual studies show positive overall results, but taken together, no significant relation between number or type of implementation interventions and improvement of outcomes could be detected. Only audit and feedback showed a significant negative influence on the improvement rate of length of stay (p = 0.003; n = 20). CONCLUSION: /st> Other hospital-specific factors are likely to have a higher impact on the rate of improvement than the implementation interventions alone. Describing which interventions are most successful is unlikely to be correct without taking these hospital-specific factors into account. Future research should focus on how to identify and define these factors and how to adapt the intervention to hospital-specific factors.

PMID: 17855445 [PubMed - as supplied by publisher]

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Do general practitioners adhere to the guideline on infectious conjunctivitis? Results of the Second Dutch National Survey of General Practice.

BMC Fam Pract. 2007 Sep 16;8(1):54

Authors: Rietveld RP, Ter Riet G, Bindels PJ, Schellevis FG, van Weert HC

ABSTRACT: INTRODUCTION: In 1996 the guideline The Red Eye of the Dutch College of General Practitioners was published. It is unclear to which extent general practitioners adhere to this guideline. Recently, data on the management of infectious conjunctivitis by general practitioners came available by the Second Dutch National Survey of General Practice. We measured the age-specific incidence of infectious conjunctivitis. We described its management by Dutch general practitioners and put these data into the perspective of the recommendations made in the guideline. METHODS: In 2001 , over a 12 months period, data of all patient contacts with 195 general practitioners were derived from electronic medical records. Registration was episode-oriented; all consultations dealing with the same health problem were grouped into disease episodes. Data of all episodes of infectious conjunctivitis (ICPC-code F70 and sub codes) were analysed. RESULTS: During one year, 5,213 new and repeating episodes of infectious conjunctivitis were presented to their general practitioner in a population of N=375,899, resulting in an overall incidence rate of 13.9 per 1000 person-years, varying from more than 80/1000 py in up to one-year olds, to less than 12/1000 py after the age of 4. Topical ophthalmic ointments were prescribed in 87% of the episodes, of which 80% was antibiotic treatment. Fusidic acid gel was most frequently prescribed (69%). General practitioners do not adhere to the guideline in most episodes. DISCUSSION: In 2001, management of infectious conjunctivitis by Dutch general practitioners was not according to a 5-years previously published consensus-based and well distributed guideline. In 2006 this guideline was revised. Its successful implementation requires more than distribution alone. Probably the most effective way to achieve this is by following a model for systemic implementation.

PMID: 17868475 [PubMed - as supplied by publisher]

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N.U.A.G.E.S: A survey of nebulisation practice in France with regard to ERS guidelines.

Respir Med. 2007 Sep 12;

Authors: de Monte M, Scruignec J, Dubus JC, Chaumuzeau JP, Dautzenberg B, Dessanges JF, Becquemin MH, Diot P,

A survey of nebulisation practice in France was conducted under the aegis of the French respiratory society in 2004. METHODS: Analysis of a questionnaire was obtained from 3674 physicians. RESULTS: A total of 2439 physicians were general practitioners (GPs), 698 were chest physicians, and 537 paediatricians. The main reasons to use nebulisation are (1) for chest physicians efficacy in treating various pathologies with long-term administration (1wk to 1 month) of approved drugs, and (2) for GP’s local action properties. While chest physicians learned about nebulisation during their university training and do not ask for additional information, GPs learned by practical experience or from colleagues and ask for further information. CONCLUSION: This study will help to develop targeted educational programmes on nebulisation practice.

PMID: 17869081 [PubMed - as supplied by publisher]

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Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre.

Br J Anaesth. 2007 Sep 14;

Authors: Wigmore TJ, Smythe JF, Hacking MB, Raobaikady R, Maccallum NS

BACKGROUND: /st> The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines. METHODS: /st> This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists. RESULTS: /st> The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%). CONCLUSIONS: /st> The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.

PMID: 17872936 [PubMed - as supplied by publisher]

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Evidence-based guidelines for interpretation of the Hamilton Rating Scale for Depression.

J Clin Psychopharmacol. 2007 Oct;27(5):531-4

Authors: Furukawa TA, Akechi T, Azuma H, Okuyama T, Higuchi T

PMID: 17873700 [PubMed - in process]

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The background and methodology of the Anaemia Cancer Treatment (A.C.T.) study: a global retrospective study of practice patterns and outcomes in the management of anaemia in cancer patients and their congruence with evidence-based guidelines.

Support Care Cancer. 2007 Sep 14;

Authors: Aapro M, Abraham I, Bokemeyer C, Ludwig H, Macdonald K, Soubeyran P, Turner M

GOAL: The benefit of supportive care with erythropoiesis-stimulating agents (ESAs) for patients with cancer-related anaemia is well known. However, the European Cancer Anaemia Survey (ECAS, data from 2001) showed that about 60% of cancer patients with anaemia do not receive any treatment. Since ECAS, evidence-based guidelines have provided recommendations for ESA use, but it is not known to what extent current treatment patterns follow these guidelines. To address this issue, the Anaemia Cancer Treatment (A.C.T.) study was initiated. The background to the development of the A.C.T. study and study methodology are described. MATERIALS AND METHODS: The A.C.T. study is a global, retrospective, pharmacoepidemiologic study of at least 2,560 medical records of anaemic patients with cancer who were previously treated with an ESA from a minimum of 186 centres. Records from patients aged greater than or equal to 18 years with a diagnosis of solid tumour or myeloma or lymphoma and who were started on ESAs 3-12 months before inclusion and followed for 8-10 weeks will be eligible. Factors associated with ESA non-responsiveness will also be evaluated. MAIN RESULTS: Completion of the European phase of the study is anticipated in late 2007 with the rest of the world closing in late 2007 or early 2008. Publication of findings is anticipated in 2008. CONCLUSIONS: By examining the extent to which anaemia management in clinical practice is congruent with best practice guidelines, the A.C.T. study will provide a further foundation for the development of evidence-based supportive cancer care.

PMID: 17874142 [PubMed - as supplied by publisher]

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Pain management and the effect of guidelines in neonatal units in Austria, Germany and Switzerland.

Pediatr Int. 2007 Oct;49(5):652-8

Authors: Gharavi B, Schott C, Nelle M, Reiter G, Linderkamp O

Background: Painful invasive procedures are frequently performed on preterm infants admitted to a neonatal intensive care unit (NICU). The aim of the present study was to investigate current pain management in Austrian, German and Swiss NICU and to identify factors associated with improved pain management in preterm infants. Methods: A questionnaire was sent to all Austrian, German and Swiss pediatric hospitals with an NICU (n = 370). Pain assessment and documentation, use of analgesics for 13 painful procedures, presence of written guidelines for pain management and the use of 12 analgesics and sedatives were examined. Results: A total of 225 units responded (61%). Pain assessment and documentation and frequent analgesic therapy for painful procedures were performed more often in units using written guidelines for pain management and in those treating >50 preterm infants at

PMID: 17875094 [PubMed - in process]

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