Evidence based secondary prevention following a myocardial infarction (MI): the new NICE guideline.

Int J Clin Pract. 2007 Oct;61(10):1604-7

Authors: Minhas R, Cooper A, Walsh JD, Williams H, Nherera L,

PMID: 17877645 [PubMed - in process]

]]>

[New german and american guidelines for therapy of hepatitis B. Discrepancies and similarities.]

Med Klin (Munich). 2007 Sep 15;102(9):763-7

Authors: Niederau C

The new German and American guidelines on hepatitis B show similarities but also some discrepancies. In general, indication for therapy depends more on hepatitis B virus-(HBV-)DNA than alanine aminotransferase (ALT) values. Antivirals are recommended by German guidelines when HBV-DNA exceeds 10,000 copies/ml and ALT is increased more than twice the upper normal limit or when liver biopsy shows significant inflammation and fibrosis. By contrast, American guidelines recommend therapy only when HBV-DNA exceeds 100,000 copies/ml. American guidelines do not recommend lamivudine or telbivudine as initial monotherapy because of risk for resistance, but adefovir or entecavir. By contrast, according to German guidelines monotherapy with lamivudine, telbivudine, adefovir or entecavir may be initiated, if HBV-DNA is

PMID: 17879015 [PubMed - in process]

]]>

Enhancing nurses’ capacity to facilitate learning in nursing students: Effective dissemination and uptake of best practice guidelines.

Int J Nurs Pract. 2007 Oct;13(5):316-20

Authors: Eaton E, Henderson A, Winch S

The preparation of nursing students for the real world of practice is a significant contemporary issue for health care and education institutions globally. Positive learning experiences are enabled through positive role models and attitudes which impact on ward culture. Although these best practices have been described, they have not been assimilated into the health-care system as the uptake of evidence is fraught with difficulties. Using the problem-solving approach of fitting evidence into practice–Read, Think, Do, this paper describes practical activities throughout the process to assimilate evidence. In particular, it details effective strategies that take into account the clinical context, such as displaying posters, demonstration of problem resolution in small group sessions and role modelling, and a presence in the clinical area. All of these contribute to the uptake of the guidelines to improve student experiences within the clinical setting.

PMID: 17883719 [PubMed - in process]

]]>

Does Adherence to the Guideline Recommendation for Active Treatments Improve the Quality of Care for Patients With Acute Low Back Pain Delivered by Physical Therapists?

Med Care. 2007 Oct;45(10):973-980

Authors: Fritz JM, Cleland JA, Brennan GP

BACKGROUND:: Numerous practice guidelines have been developed for patients with low back pain in an attempt to reduce inappropriate variations and improve the cost-effectiveness of care. Guideline implementation has received more research attention than the impact of adherence to guideline recommendations on outcomes and costs of care. OBJECTIVE:: Examine the association between adherence to the guideline recommendation to use active versus passive treatments with clinical outcomes and costs for patients with acute low back pain receiving physical therapy. RESEARCH DESIGN:: Retrospective review of patients with acute low back pain receiving physical therapy in 2004-2005. Adherence to the recommendation for active treatment was determined from billing records. Clinical and financial outcomes were compared between patients receiving adherent or nonadherent care. SUBJECTS:: A total of 1190 patients age 18-60 years old with low back pain of less than 90 days duration in 10 clinics in 1 geographic region. MEASURES:: Clinical outcomes included the numeric pain rating and Oswestry disability questionnaire taken initially and at the completion of treatment. Financial outcomes included the number of sessions and charges for physical therapy care. RESULTS:: Adherence rate was 40.4%. Adherence was greater for patients receiving workers’ compensation (P

PMID: 17890995 [PubMed - as supplied by publisher]

]]>

[Uncomplicated Plasmodium vivax and P. falciparum malaria in Brazil: evidence on single and combined drug treatments recommended by official guidelines.]

Cad Saude Publica. 2007 Oct;23(10):2285-94

Authors: Freitas LF, Chaves GC, Wannmacher L, Osorio-de-Castro CG

Malaria is the most important endemic parasitic disease in the world. Conditions are favorable for transmission of the disease in 60% of Brazil’s territory. Over 500,000 cases per year are recorded in the country. However, the geographic distribution is uneven, which may explain differences in the efficacy and effectiveness of antimalarial drugs. We conducted an extensive literature review of antimalarial treatment in Brazil from 1980 to 2005 in order to identify evidence that might have been available for the 2001 Edition of the Malaria Treatment Manual, the official Ministry of Health guidelines. Only a few studies, of low methodological quality, were identified by the search. None of the studies would have been capable of generating evidence-based guidelines according to the current classification of levels of pharmacological and clinical evidence. Studies published after 2001 drew on more evidence and are expected to provide the basis for the next edition of the manual, due in 2007. References in the 2001 Edition were outdated, possibly perceived as traditional references in the field, but lacking in specificity for region, population, and/or type of malaria.

PMID: 17891290 [PubMed - in process]

]]>

Guidelines for Cardiac Management in Noncardiac Surgery Are Poorly Implemented in Clinical Practice: Results from a Peripheral Vascular Survey in The Netherlands.

Anesthesiology. 2007 Oct;107(4):537-544

Authors: Hoeks SE, Scholte Op Reimer WJ, Lenzen MJ, van Urk H, Jörning PJ, Boersma E, Simoons ML, Bax JJ, Poldermans D

BACKGROUND:: The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery recommend an algorithm for a stepwise approach to preoperative cardiac assessment in vascular surgery patients. The authors’ main objective was to determine adherence to the ACC/AHA guidelines on perioperative care in daily clinical practice. METHODS:: Between May and December 2004, data on 711 consecutive peripheral vascular surgery patients were collected from 11 hospitals in The Netherlands. This survey was conducted within the infrastructure of the Euro Heart Survey Programme. The authors retrospectively applied the ACC/AHA guideline algorithm to each patient in their data set and subsequently compared observed clinical practice data with these recommendations. RESULTS:: Although 185 of the total 711 patients (26%) fulfilled the ACC/AHA guideline criteria to recommend preoperative noninvasive cardiac testing, clinicians had performed testing in only 38 of those cases (21%). Conversely, of the 526 patients for whom noninvasive testing was not recommended, guidelines were followed in 467 patients (89%). Overall, patients who had not been tested, irrespective of guideline recommendation, received less cardioprotective medications, whereas patients who underwent noninvasive testing were significantly more often treated with cardiovascular drugs (beta-blockers 43% vs. 77%, statins 52% vs. 83%, platelet inhibitors 80% vs. 85%, respectively; all P

PMID: 17893448 [PubMed - as supplied by publisher]

]]>

Implementing guidelines: what works.

Arch Dis Child Educ Pract Ed. 2007 Oct;92(5):ep129-34

Authors: Livesey EA, Noon JM

PMID: 17895261 [PubMed - in process]

]]>

Guidelines for the diagnosis and management of cow’s milk protein allergy in infants.

Arch Dis Child. 2007 Oct;92(10):902-8

Authors: Vandenplas Y, Brueton M, Dupont C, Hill D, Isolauri E, Koletzko S, Oranje AP, Staiano A

Our aim was to develop guidance for general paediatricians and primary care physicians in diagnosing and managing cow’s milk protein allergy in infants. The guidelines were developed by discussion based on existing national recommendations and standards, clinical experience and, whenever possible, evidence from the literature. Separate algorithms cover breast-fed and formula-fed infants. The recommendations emphasise the importance of comprehensive history taking and careful physical examination. Patients with severe symptoms need to be referred to a specialist. Elimination of cow’s milk protein from the infant’s or mother’s diet and challenges are the gold standard for diagnosis. This guidance is intended as a basis for local discussion, implementation and prospective evaluation. The algorithms should be regularly assessed using clinical audit standards. Once validated, the diagnostic framework could provide a standardised approach in epidemiological and therapeutic studies.

PMID: 17895338 [PubMed - in process]

]]>

Assessment of cumulative evidence on genetic associations: interim guidelines.

Int J Epidemiol. 2007 Sep 26;

Authors: Ioannidis JP, Boffetta P, Little J, O’brien TR, Uitterlinden AG, Vineis P, Balding DJ, Chokkalingam A, Dolan SM, Flanders WD, Higgins JP, McCarthy MI, McDermott DH, Page GP, Rebbeck TR, Seminara D, Khoury MJ

Established guidelines for causal inference in epidemiological studies may be inappropriate for genetic associations. A consensus process was used to develop guidance criteria for assessing cumulative epidemiologic evidence in genetic associations. A proposed semi-quantitative index assigns three levels for the amount of evidence, extent of replication, and protection from bias, and also generates a composite assessment of ‘strong’, ‘moderate’ or ‘weak’ epidemiological credibility. In addition, we discuss how additional input and guidance can be derived from biological data. Future empirical research and consensus development are needed to develop an integrated model for combining epidemiological and biological evidence in the rapidly evolving field of investigation of genetic factors.

PMID: 17898028 [PubMed - as supplied by publisher]

]]>

[Application of the current resuscitation guidelines 2005 : Case report of successful cardiopulmonary resuscitation.]

Anaesthesist. 2007 Sep 26;

Authors: Eppinger M, Flury G, Wenzel V, Koppenberg J

The international guidelines for cardiopulmonary resuscitation are subject to continuous modification and were revised in November 2005. This report describes a case of an out-of-hospital cardiopulmonary resuscitation where the patient survived a cardiac arrest without neurological sequelae after chest compression (30:2), bag-mask ventilation and multiple biphasic defibrillation (single shocks). This article gives a practical review of the most important new recommendations in the current resuscitation guidelines. The accomplished measures are discussed on the background of the new recommendations.

PMID: 17898968 [PubMed - as supplied by publisher]

]]>