Domestic and foreign trends in the prevalence of heart failure and the necessity of next-generation artificial hearts: a survey by the Working Group on Establishment of Assessment Guidelines for Next-Generation Artificial Heart Systems.

J Artif Organs. 2007;10(4):187-94

Authors: Tatsumi E, Nakatani T, Imachi K, Umezu M, Kyo SE, Sase K, Takatani S, Matsuda H

A series of guidelines for development and assessment of next-generation medical devices has been drafted under an interagency collaborative project by the Ministry of Health, Labor and Welfare and the Ministry of Economy, Trade and Industry. The working group for assessment guidelines of next-generation artificial hearts reviewed the trend in the prevalence of heart failure and examined the potential usefulness of such devices in Japan and in other countries as a fundamental part of the process of establishing appropriate guidelines. At present, more than 23 million people suffer from heart failure in developed countries, including Japan. Although Japan currently has the lowest mortality from heart failure among those countries, the number of patients is gradually increasing as our lifestyle becomes more Westernized; the associated medical expenses are rapidly growing. The number of heart transplantations, however, is limited due to the overwhelming shortage of donor hearts, not only in Japan but worldwide. Meanwhile, clinical studies and surveys have revealed that the major causes of death in patients undergoing long-term use of ventricular assist devices (VADs) were infection, thrombosis, and mechanical failure, all of which are typical of VADs. It is therefore of urgent and universal necessity to develop next-generation artificial hearts that have excellent durability to provide at least 2 years of event-free operation with a superior quality of life and that can be used for destination therapy to save patients with irreversible heart failure. It is also very important to ensure that an environment that facilitates the development, testing, and approval evaluation processes of next-generation artificial hearts be established as soon as possible.

PMID: 18071846 [PubMed - in process]

]]>

Mammography screening of women in their 40s: impact of changes in screening guidelines.

Cancer. 2007 Dec 10;

Authors: Calvocoressi L, Sun A, Kasl SV, Claus EB, Jones BA

BACKGROUND.: In March 1997, the American Cancer Society (ACS) updated its recommended mammography screening interval for women ages 40-49 years from once every 1 to 2 years to once every year. At the same time, the National Cancer Institute (NCI), which had previously not recommended routine screening of women in their 40s, began recommending screening at 1 to 2-year intervals. These events occurred during the data collection phase of a prospective study of mammography screening and, thereby, provided an unexpected opportunity to examine the potential influences of changing guidelines on women’s beliefs about how frequently they should obtain screening exams. METHODS.: This analysis included 1451 African American and white women ages 40-79 years, who obtained an “index” screening exam between October 1996 and January 1998. In baseline and 2-year follow-up telephone interviews, respondents provided information on demographic, socioeconomic, health history, medical care, behavioral and psychosocial factors, and on how frequently they believed women of their age should obtain screening mammograms. RESULTS.: After the ACS and NCI announcements of new screening guidelines for women in their 40s, a significant increase in endorsement of annual screening among women ages 40-49 years was observed, consistent with the ACS recommendation for annual screening in that age group. No increase in endorsement of annual screening among women ages 50 years and older was evident during the same time period. CONCLUSIONS.: Women’s beliefs about how frequently they should obtain mammography screenings appear to change in response to changes in recommendations of high-profile health organizations, particularly when those recommendations call for an increase in screening. Cancer 2008. (c) 2007 American Cancer Society.

PMID: 18072258 [PubMed - as supplied by publisher]

]]>

Solicited editorial for Mammography Screening of Women in Their Forties : the impact of changes in screening guidelines.

Cancer. 2007 Dec 10;

Authors: Brem RF

PMID: 18072262 [PubMed - as supplied by publisher]

]]>

Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis.

Spine J. 2007 Dec 12;

Authors: Watters WC, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF

BACKGROUND CONTEXT: The objective of the North American Spine Society (NASS) evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (DLSS) is to provide evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of DLSS. The guideline is intended to reflect contemporary treatment concepts for symptomatic DLSS as reflected in the highest quality clinical literature available on this subject as of April 2006. The goals of the guideline recommendations are to assist in delivering optimum, efficacious treatment, and functional recovery from this spinal disorder. PURPOSE: To provide an evidence-based tool that assists practitioners in improving the quality and efficiency of care delivered to patients with DLSS. STUDY DESIGN/SETTING: Evidence-based clinical guideline. METHODS: This report is from the Spinal Stenosis Work Group of the NASS Clinical Guidelines Committee. The work group comprised medical, diagnostic, interventional, and surgical spinal care specialists, all of whom were trained in the principles of evidence-based analysis. In the development of this guideline, the work group arrived at a consensus definition of a working diagnosis of lumbar spinal stenosis by use of a modification of the nominal group technique. Each member of the group formatted a series of clinical questions to be addressed by the group and the final list of questions agreed on by the group is the subject of this report. A literature search addressing each question and using a specific literature search protocol was performed on English language references found in MEDLINE, EMBASE (Drugs and Pharmacology), and four additional, evidence-based, databases. The relevant literature to answer each clinical question was then independently rated by at least two reviewers using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Any discrepancies in evidence levels among the initial raters were resolved by at least two additional members’ review of the reference and independent rating. Final grades of recommendation for the answer to each clinical question were arrived at in face-to-face meetings among members of the work group using the NASS-adopted standardized grades of recommendation. When Levels I to IV evidence was insufficient to support a recommendation to answer a specific clinical question, expert consensus was arrived at by the work group through the modified nominal group technique and is clearly identified as such in the guideline. RESULTS: Eighteen clinical questions were asked, addressing issues of prognosis, diagnosis, and treatment of DLSS. The answers to these 18 clinical questions are summarized in this document along with their respective levels of evidence and grades of recommendation in support of these answers. CONCLUSIONS: A clinical guideline for DLSS has been created using the techniques of evidence-based medicine and using the best available evidence as a tool to aid both practitioners and patients involved with the care of this disease. The entire guideline document including the evidentiary tables, suggestions for future research, and all references is available electronically at the NASS Web site (www.spine.org) and will remain updated on a timely schedule.

PMID: 18082461 [PubMed - as supplied by publisher]

]]>

Assessment of Attitudes of Intensive Care Unit Staff Toward Clinical Practice Guidelines.

Dimens Crit Care Nurs. 2008 January/February;27(1):30-38

Authors: Pogorzelska M, Larson EL

Although studies on the implementation and adherence to specific practice guidelines have been proliferating, research examining the attitude of healthcare workers toward practice guidelines in general has been lacking. This study is a secondary analysis of data collected from 39 volunteer hospitals participating in the National Nosocomial Infection Surveillance System on attitudes of intensive care unit staff regarding practice guidelines in general. Age, profession, type of intensive care unit, and race were identified as significant predictors of attitude scores in this study. Understanding the differences in perceived barriers is important for the adherence to practice guidelines.

PMID: 18091633 [PubMed - as supplied by publisher]

]]>

Provider Selection of Evidence-Based Contraception Guidelines in Service Provision : A Study in India, Peru, and Rwanda.

Eval Health Prof. 2007 Dec 21;

Authors: León FR, Lundgren R, Jennings V

Providers underutilize evidence-based practice guidelines as they prescribe contraceptives. To discern biases in guideline utilization by 172 providers of three countries, this study used observations from simulated clients trained to choose oral contraceptives. Providers implemented less than one third of the guideline set, but they addressed, more frequently than other guidelines, items categorized as essential by expert opinion (p

PMID: 18156443 [PubMed - as supplied by publisher]

]]>

Critical care nurses’ Knowledge of Evidence-Based Guidelines for Preventing Infections Associated With Central Venous Catheters: An Evaluation Questionnaire.

Am J Crit Care. 2008 Jan;17(1):65-71

Authors: Labeau S, Vereecke A, Vandijck DM, Claes B, Blot SI,

Background Lack of adherence to recommended evidence-based guidelines for preventing infections associated with use of central venous catheters may be due to nurses’ lack of knowledge of the guidelines. Objective To develop a reliable and valid questionnaire for evaluating critical care nurses’ knowledge of evidence-based guidelines for preventing infections associated with central venous catheters. Methods A total of 10 nursing-related strategies were identified from current evidence-based guidelines for preventing infections associated with use of central venous catheters. Face and content validation were determined for selected interventions and multiple-choice questions (1 question per intervention). The test results of 762 critical care nurses were evaluated for item difficulty, item discrimination, and quality of the response alternatives or options for answers (possible responses). Results All 10 items had face and content validity. Values for item difficulty ranged from 0.1 to 0.9. Values for item discrimination ranged from 0.05 to 0.41. The quality of the response alternatives (0.0-0.8) indicated widespread misconceptions among the critical care nurses in the sample. Conclusion The questionnaire is reliable and has face and content validity. Findings from surveys in which this questionnaire is used can lead to better educational programs for critical care nurses on infections associated with use of central venous catheters.

PMID: 18158392 [PubMed - as supplied by publisher]

]]>

Ventilator discontinuation process: Evidence and guidelines.

Crit Care Med. 2008 Jan;36(1):329-30

Authors: Macintyre N

PMID: 18158439 [PubMed - in process]

]]>

Implementation of new technologies in automatic external defibrillators using guidelines for cardiopulmonary resuscitation.

Crit Care Med. 2008 Jan;36(1):355-356

Authors: Fauchier L, Pierre B

PMID: 18158456 [PubMed - as supplied by publisher]

]]>

A qualitative examination of current guidelines for evidence-based practice in child language intervention.

Lang Speech Hear Serv Sch. 2008 Jan;39(1):78-88

Authors: Brackenbury T, Burroughs E, Hewitt LE

PURPOSE: The present investigation examines the time, effort, and resources that evidence-based practice (EBP) requires, and looks at what types of results are obtained. METHOD: Principles of EBP as outlined by the American Speech-Language-Hearing Association were applied to 3 treatment case studies. RESULTS: The cases took between 3 and 7 hr to complete and yielded different amounts and types of results. Individual article searches yielded better results than did searches of systematic reviews. Most evidence found was from small-group and individual case studies. CONCLUSION: EBP is a necessary part of effective and ethical treatment. The resources needed, time involved, and availability of relevant information make current guidelines for EBP challenging for most full-time practitioners. Specific recommendations to address these concerns are offered.

PMID: 18162650 [PubMed - in process]

]]>