Individual advice in addition to standard guideline care in patients with acute non-specific low back pain: A survey on feasibility among physiotherapists and patients.

Man Ther. 2007 Dec 28;

Authors: Bakker EW, Verhagen AP, van Trijffel E, Lucas C, Koning HJ, Koes BW

The medical costs associated with low back pain (LBP) potentially pose an enormous economic burden to society. Prevention (secondary) might be beneficial when there is no definitive conclusion on the most appropriate intervention. For this purpose, individual advice focusing on modification of spinal mechanical load obtained with the 24 Hour Schedule-24HS-(an instrument for quantifying spinal mechanical load) in addition to standard care of guideline-recommendations might be effective. Naturally, this should be examined in controlled studies. Considering the costs involved carrying out a controlled study, the feasibility of 24HS-advice should be assessed first. We performed two surveys in primary care setting in 97 patients with acute (

PMID: 18165146 [PubMed - as supplied by publisher]

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Antibiotic use in five children’s hospitals during 2002-2006: the impact of antibiotic guidelines issued by the Chinese Ministry of Health.

Pharmacoepidemiol Drug Saf. 2007 Dec 28;

Authors: Zhang W, Shen X, Wang Y, Chen Y, Huang M, Zeng Q, Wei J, Lu Q, Wang G, Deng L, Wang X, Yao K, Yu S, Yang Y

PURPOSE: To investigate the pattern of antibiotic use in five Chinese children’s hospitals from 2002 to 2006. To see if the Guidelines to encourage rational use of antibiotics issued by the Ministry of Health in October 2004 have any impact on the use. METHODS: The Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) methodology was used. Aggregate data on antibiotic use (ATC code-J01) were expressed in numbers of DDD/100 bed-days for inpatients. RESULTS: Total 56 different substances of systemic antibiotics were used. The overall consumption of antibiotic drugs was 68.2, 58.4, 65.8, 65.6 and 49.9 DDD/100 bed-days for the years 2002-2006, respectively. The top antibiotics used were third-generation cephalosporins. There was considerable variation in both type and amount of antibiotics used in the five hospitals. In 2002, some hospitals had twice the antibiotic use compared to others. While the overall antibiotic use in 2005 was largely unchanged compared with previous years, by 2006 antibiotic use had decreased by 22.6% and the variation in use between hospitals was also reduced. CONCLUSIONS: The ATC/DDD methodology proved useful for studying overall antibiotic usage in children’s hospitals. The decline in antibiotic usage found in 2006 (and the reduced variation between hospitals) may be attributed to the impact of the Ministry of Health guidelines which took some time to be promulgated to individual staff members. Further research will focus on compliance of antibiotic use in these five hospitals with particular guideline recommendations for specific clinical problems such as bacterial resistance and surgical antibiotic prophylaxis. Copyright (c) 2008 John Wiley & Sons, Ltd.

PMID: 18165944 [PubMed - as supplied by publisher]

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Elemental mercury exposure: An evidence-based consensus guideline for out-of-hospital management.

Clin Toxicol (Phila). 2008 Jan;46(1):1-21

Authors: Caravati EM, Erdman AR, Christianson G, Nelson LS, Woolf AD, Booze LL, Cobaugh DJ, Chyka PA, Scharman EJ, Manoguerra AS, Troutman WG

The objective of this guideline is to assist poison center personnel in the out-of-hospital triage and initial management of patients with suspected exposures to elemental mercury. An evidence-based expert consensus process was used to create this guideline. It is based on an assessment of current scientific and clinical information. The panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and health professionals providing care. The grade of recommendation is in parentheses. Recommendations: 1) Patients with exposure due to suspected self-harm, abuse, misuse, or potentially malicious administration should be referred to an emergency department immediately regardless of the exposure reported (Grade D). 2) Patients with symptoms of acute elemental mercury poisoning (e.g., cough, dyspnea, chest pain) should be referred immediately to an emergency department for evaluation regardless of the reported dose. Patients with symptoms of chronic toxicity (rash, tremor, weight loss, etc.) should be referred for healthcare evaluation, the timing and location of which is guided by the severity of illness and circumstances of the exposure (Grade C). 3) If the elemental mercury was recently heated (e.g., from stove top, oven, furnace) in an enclosed area, all people within the exposure area should be evaluated at a healthcare facility due to the high risk of toxicity (Grade C). 4) If the elemental mercury was vacuumed or swept with a broom, the health department should be contacted to perform an environmental assessment for mercury contamination. Consider healthcare referral for those exposed to documented high air mercury concentrations (Grade C). 5) Patients ingesting more mercury than in a household fever thermometer or those with abdominal pain after ingestion should be referred to an emergency department for evaluation (Grade C). Do not induce emesis or administer activated charcoal. 6) Asymptomatic patients with brief, unintentional, low-dose vapor exposures can be observed at home. Asymptomatic patients can be evaluated as non-urgent outpatients if there is concern for exposures to high doses (e.g., more than contained in a thermometer) or for chronic duration (Grade D). 7) Pregnant patients unintentionally exposed to elemental mercury and who are asymptomatic should be evaluated by their obstetrician or primary care provider as an outpatient. Immediate referral to an ED is not required (Grade D). 8) Patients with elemental mercury deposited or injected into soft tissue should be referred for evaluation of surgical removal (Grade C). 9) All elemental mercury spills should be properly cleaned up, including the small amount of mercury from a broken thermometer. Brooms and vacuum cleaners should not be used to clean up elemental mercury. The clean-up of any spill larger than a broken thermometer should be performed by a professional company, state health department, or the EPA. Detailed instructions are provided on the EPA website: www.epa.gov/epaoswer/hazwaste/mercury/faq/spills.htm (Grade D). 10) Patients with dermal exposures should remove all jewelry and wash the affected area with mild soap and water. Remove all contaminated clothing and place these items in a sealed plastic double-bag for proper disposal (Grade D). 11) Do not discard elemental mercury in household trash, plumbing drains, or sewer systems. Consult local authorities for the proper disposal of low-level elemental mercury-contaminated household items and thermometers (Grade D).

PMID: 18167033 [PubMed - in process]

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Medical residents’ self-reported adherence to guidelines during placement of central venous catheters *.

Infect Control Hosp Epidemiol. 2008 Jan;29(1):86-8

Authors: Al Aloul BK, Adabag AS, Goussous TY, Weinert CR

In teaching hospitals, the majority of central venous catheters are placed by medical residents. No studies have examined residents’ adherence to safe practices during these procedures. We conducted a survey to gather self-reported data on the techniques that internal medicine residents use when placing a central venous catheter to minimize their own risk of infection and their patients’ risk of bleeding-related complications.

PMID: 18171196 [PubMed - in process]

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Sputum smear microscopy: evaluation of the impact of training, microscope distribution, and the use of External Quality Assessment Guidelines for resource poor settings.

J Clin Microbiol. 2008 Jan 3;

Authors: Van Rie A, Fitzgerald D, Kabuya G, Van Deun A, Tabala M, Jarret N, Behets F, Bahati E

Sputum smear microscopy is the main and often only laboratory technique used for diagnosis of tuberculosis in resource poor countries, making quality assurance (QA) of smear microscopy an important activity. We evaluated the effect of a five-day refresher training for laboratory technicians and distribution of new microscopes on the quality of smear microscopy in thirteen primary health care laboratories in Kinshasa, Democratic Republic of Congo. The 2002 External Quality Assessment for AFB Smear Microscopy guidelines were implemented and blinded rechecking of slides was performed before and nine months after training and microscope distribution. We observed that the on-site checklist was highly time-consuming but could be tailored to capture frequent problems. Random blinded rechecking using the Lot Quality Assurance Sampling method decreased the number of slides to be reviewed. Most laboratories needed further investigation for possible unacceptable performance, even according to the least stringent interpretation. We conclude that the 2002 QC guidelines are feasible for implementation in resource poor settings, that efficiency of EQA can be increased by selecting sample size parameters and interpretation criteria that take into account local working conditions, and that greater attention should be paid to timely feedback and correction of the causes of poorly performing laboratories.

PMID: 18174302 [PubMed - as supplied by publisher]

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Management of Acute Childhood Idiopathic Thrombocytopenic Purpura according to AIEOP Consensus Guidelines: Assessment of Italian Experience.

Acta Haematol. 2008 Jan 4;119(1):1-7

Authors: Del Vecchio GC, De Santis A, Giordano P, Amendola G, Baronci C, Del Principe D, Nobili B, Jankovic M, Ramenghi U, Russo G, Zecca M, De Mattia D

Background: Consensus guidelines for diagnosis and treatment of acute childhood idiopathic thrombocytopenic purpura (ITP) were published in 2000 by the Italian Association of Pediatric Haematology and Oncology (AIEOP). The assessment of guideline implementation was the primary objective of the present study. Patients and Methods: Information on each newly diagnosed case of ITP referring to centres conforming with the guidelines was obtained by a questionnaire. Results: Data concerning 609 new cases of acute childhood ITP were collected including 346 (56.8%) asymptomatic-paucisymptomatic forms (type A), 262 (43%) intermediate clinical forms (type B), and 1 (0.2%) severe form (type C). At diagnosis, 82% of cases were hospitalized. Age, platelet count and duration of hospitalization were significantly different in type A and type B cases. Of the total number of cases, 25% were kept under observation, 38.6% received intravenous immunoglobulins, 23.9% oral or parenteral steroids, and 12.7% other treatments. The initial treatment turned out to be appropriate for 428 cases (72.2%), of uncertain appropriateness in 71 (11.9%), and inappropriate in 95 cases (15.9%). The total level of implementation was 84.1%. Conclusions: A high rate of guideline implementation was observed during the study period. The guidelines should be reviewed taking into account more recent evidence. Copyright (c) 2008 S. Karger AG, Basel.

PMID: 18176072 [PubMed - as supplied by publisher]

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[Implementation of guidelines: Include the peers to increase anaesthetists' adherence.]

Ann Fr Anesth Reanim. 2008 Jan 4;

Authors: Vignally P, Sambuc R, Gentile S

PMID: 18178365 [PubMed - as supplied by publisher]

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