Implementing clinical guidelines for bipolar disorder.

Psychol Psychother. 2008 Jan 22;

Authors: Morriss R

PurposeTo critically review the evidence concerning the implementation of clinical guidelines for bipolar disorder.MethodsA Medline search was made of the literature on the implementation of guidelines in bipolar disorder and mental health. The implementation of non-pharmacological treatments from the 2006 NICE Guideline for Bipolar Disorder was then used as a case example. May’s model of normalization of complex interventions was then applied to the NICE guideline recommendations for bipolar disorder.ResultsThe effective local implementation of guidelines requires a detailed understanding of local barriers to their implementation. Some recommendations in the NICE Guideline on advanced directives and management of anxiety disorder in bipolar disorder appear to follow the existing trends in practice and are more likely to be implemented. Interventions concerning the psychological management of bipolar depression and maintenance psychological treatments are going to be the most difficult to implement because of shortages of skilled staff, the absence of specific training and supervision, the requirements for staff to adopt practices that are quite different from what they are used to, and some uncertainty about whether these interventions are effective in the most severe patients.ConclusionsWithout a detailed local understanding of the barriers to implementation and the resources and will to overcome them, there is likely to be a considerable local variation in the implementation of guidelines for bipolar disorder. Recommendations that require little change to working practices and resources are most likely to be implemented.

PMID: 18215339 [PubMed - as supplied by publisher]

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Facilitating clinician adherence to guidelines in the intensive care unit.

Crit Care Med. 2008 Feb;36(2):655

Authors: Vandijck DM, Labeau SO, Blot SI

PMID: 18216641 [PubMed - in process]

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Contemporary treatment and adherence to guidelines in women and men with acute coronary syndromes.

Int J Cardiol. 2008 Jan 25;

Authors: Moriel M, Tzivoni D, Behar S, Zahger D, Hod H, Hasdai D, Sandach A, Gottlieb S

BACKGROUND: Historically gender differences existed in treatment and outcome of patients with acute myocardial infarction (MI). AIM: To assess gender aspects of contemporary treatment and adherence to ACC/AHA Class-I Treatment Guidelines in patients with acute coronary syndrome (ACS). METHODS: We studied 2024 consecutive patients (519 women, 26%); 1026 (51%) with ST-elevation (STE)-MI and 998 (49%) patients with non-STE (NSTE), during a nationwide ACS-survey, conducted during 2-months in 2004. RESULTS: Women were older than men (71 vs. 59 in STEMI; 71 vs. 64 years in NSTE-ACS patients), and had worse cardiovascular risk profiles. In STEMI-patients, acute reperfusion was less frequent in women than in men (53% vs. 63%, respectively, p=0.01; non-significant after age-adjustment). At discharge, fewer women received ACE-inhibitors/ARBs (71% vs. 75%, respectively; OR(age-adj)=0.69[0.48-0.98]). Among NSTE-ACS patients, fewer women received IIb/IIIa-inhibitors (12% vs. 21%, respectively, p=0.007; OR(age-adj)=0.58[0.36-0.96]) and clopidogrel at discharge (49% vs. 59%, respectively, p=0.005; OR(age-adj) 0.75[0.56-1.01]). No gender differences were noted in utilization of aspirin, beta-blockers or statins. Age-adjusted and covariate-adjusted mortality rates were comparable in women and men with STEMI (at 7-days 4.3% vs. 4.1%; OR(adj)=0.95[0.47-1.87] and at 1-year 13.8% vs. 9.8%, hazard ratio [HR(adj)]=1.11[0.73-1.70], respectively); in women and men with NSTE-ACS (at 7-days 1.3% vs. 2.1%, OR(adj)=0.65[0.20-1.76], and at 1-year 12.0% vs. 11.3%; HR(adj)=1.19[0.80-1.77], respectively). CONCLUSIONS: In 2004, adherence to ACC/AHA Class-I Treatment Guidelines in ACS-patients was satisfactory. Relative underutilization of acute reperfusion was noted among STEMI patients, without gender differences after age-adjustment. At discharge, less women received ACE-inhibitors/ARBs. Among NSTE-ACS patients, less women than men received IIb/IIIa-inhibitors, and clopidogrel at discharge. Contemporary ACS management was associated with similar adjusted outcome in women and men.

PMID: 18222551 [PubMed - as supplied by publisher]

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Review: more high quality studies needed to determine the effects on patient outcomes of psychiatric care guideline implementation.

Evid Based Ment Health. 2008 Feb;11(1):21

Authors: Cheung AH

PMID: 18223056 [PubMed]

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Assessment of a treatment guideline to improve home management of malaria in children in rural south-west Nigeria.

Malar J. 2008 Jan 29;7(1):24

Authors: Ajayi IO, Falade CO, Bamgboye AE, Oduola AM, Kale OO

ABSTRACT: BACKGROUND: Many Nigerian children with malaria are treated at home. Treatments are mostly incorrect, due to caregivers’ poor knowledge of appropriate and correct dose of drugs. A comparative study was carried out in two rural health districts in southwest Nigeria to determine the effectiveness of a guideline targeted at caregivers, in the treatment of febrile children using chloroquine. METHODS: Baseline and post intervention knowledge, attitude and practice household surveys were conducted. The intervention strategy consisted of training a core group of mothers (amother trainersa) in selected communities on the correct treatment of malaria and distributing a newly developed treatment guideline to each household. “Mother trainers” disseminated the educational messages about malaria and the use of the guideline to their communities. RESULTS: Knowledge of cause, prevention and treatment of malaria increased with the one-year intervention. Many, (70.4%) of the respondents stated that they used the guideline each time a child was treated for malaria. There was a significant increase in the correct use of chloroquine from 2.6% at baseline to 52.3% after intervention among those who treated children at home in the intervention arm compared with 4.2% to 12.7% in the control arm. The correctness of use was significantly associated with use of the guideline. The timeliness of commencing treatment was significantly earlier in those who treated febrile children at home using chloroquine than those who took their children to the chemist or health facility (p

PMID: 18226272 [PubMed - as supplied by publisher]

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A Clinical Evaluation of the Cost and Time Effectiveness of the ASPAN Hypothermia Guideline.

J Perianesth Nurs. 2008 Feb;23(1):24-35

Authors: Berry D, Wick C, Magons P

It is known that perioperative hypothermia increases the cost of care and places surgical patients at increased risk for adverse outcomes. The American Society of PeriAnesthesia Nurses (ASPAN) developed the Clinical Guideline for the Prevention of Unplanned Perioperative Hypothermia to specify a systematic approach to the maintenance of normothermia in surgical patients, making use of newer active warming technologies as well as passive warming techniques. The purpose of this study was to test the cost and time effectiveness of the ASPAN Hypothermia Guideline as compared with usual care. Our findings indicate that the Hypothermia Guideline, which is known to employ practices effective for maintaining normothermia, is clinically feasible and can be implemented without significant increases in cost or time for an ambulatory surgical unit.

PMID: 18226782 [PubMed - in process]

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Evidence and interdisciplinary consensus-based German guidelines: surgical treatment and radiotherapy of melanoma.

Melanoma Res. 2008 Feb;18(1):61-67

Authors: Garbe C, Hauschild A, Volkenandt M, Schadendorf D, Stolz W, Reinhold U, Kortmann RD, Kettelhack C, Frerich B, Keilholz U, Dummer R, Sebastian G, Tilgen W, Schuler G, Mackensen A, Kaufmann R

The primary treatment of a melanoma is surgical excision. An excisional biopsy is preferred, and safety margins of 1 cm for tumor thickness up to 2 mm and 2 cm for higher tumor thickness should be applied either at primary excision or in a two-step procedure. When dealing with facial, acral or anogenital melanomas, micrographic control of the surgical margins may be preferable to allow reduced safety margins and conservation of tissue. The sentinel lymph node biopsy should be performed in patients whose primary melanoma is thicker than 1.0 mm and this operation should be performed in centers where both the operative and nuclear medicine teams are experienced. In clinically identified lymph node metastases, radical lymph node dissection is considered standard therapy. If distant metastases involve just one internal organ and operative removal is feasible, then surgery should be seen as therapy of choice. Radiation therapy for the primary treatment of melanoma is indicated only in those cases in which surgery is impossible or not reasonable. In regional lymph nodes, radiation therapy is usually recommended when excision is not complete (R1 resection) or if the nodes are inoperable. In distant metastases, radiation therapy is particularly indicated in bone metastases, brain metastases and soft tissue metastases.

PMID: 18227710 [PubMed - as supplied by publisher]

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The 2-week rule for suspected head and neck cancer in the United Kingdom: Referral patterns, diagnostic efficacy of the guidelines and compliance.

Oral Oncol. 2008 Jan 28;

Authors: McKie C, Ahmad UA, Fellows S, Meikle D, Stafford FW, Thomson PJ, Welch AR, Paleri V

A retrospective audit of 1079 2-week referrals between 1 January 2004 and 31 December 2006 was undertaken. The aims of this audit were to assess compliance of referrals with Department of Health (DoH) guidelines; the effectiveness of the 2-week referral route in detecting head and neck cancers, and to determine whether this route identified more early stage cancers. Of 1079 2-week referrals, 71.5% conformed to DoH criteria. DoH guidelines were found to have a high sensitivity of 83.9% (75.5-89.7%, 95% CI) for head and neck cancer, but a low positive predictive value of 12.8% (10.5-15.3%) and a specificity of 30.0% (27.2-33.1%). Only 10.9% of 2-week referrals were diagnosed with a head and neck cancer. The cancer detection rate was higher amongst referrals that conformed to DoH guidelines (12.8%) compared to those that did not 6.2%. This was statistically significant (Chi square, p

PMID: 18234546 [PubMed - as supplied by publisher]

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Practical guidelines for the management of interferon-alpha-2b side effects in patients receiving adjuvant treatment for melanoma: expert opinion.

Cancer. 2008 Jan 30;

Authors: Hauschild A, Gogas H, Tarhini A, Middleton MR, Testori A, Dréno B, Kirkwood JM

Interferon-alpha-2b (IFNalpha2b) is the only effective adjuvant therapy for melanoma patients at high risk of recurrence that has been approved by regulatory authorities worldwide. However, IFN toxicities increase the risk of poor treatment compliance and impair the potential for benefit from this agent. A review of the literature demonstrated little recent attention to supportive care in the management of IFN toxicities. An international group of experts with extensive personal experience in the use of IFNs worked together to develop practical guidelines for the use of IFNs. Practical recommendations were developed for patient education on the use of IFN; initial patient assessment and monitoring, including contraindications to the use of IFN, monitoring and managing adverse events, and IFN dose modification and discontinuation; IFN injection procedures; treatment of elderly patients; and use during pregnancy and nursing. Successful adjuvant therapy of melanoma with high-dose IFN requires close compliance with the treatment regimen. Recommendations for the recognition and management of adverse events are designed to enable more patients to complete the full planned course of treatment. Cancer 2008. (c) 2008 American Cancer Society.

PMID: 18236459 [PubMed - as supplied by publisher]

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[Guideline compliance in hip fracture : Results of an external quality-assurance program in North Rhine Westphalia: 2003-2005.]

Unfallchirurg. 2008 Feb 2;

Authors: Schulze Raestrup U, Grams A, Smektala R

BACKGROUND: Whereas the Scottish guidelines are audited annually, nobody evaluates guideline compliance in Germany. Thus, can external quality assurance data pursuant to section 137 of the German Social Code Book V be suitable for auditing guideline compliance? MATERIALS AND METHODS: From North Rhine Westphalia, a total of 48,831 cases of femoral fractures near the hip joint were evaluated. Compliance with the guidelines was determined based on preoperative hospital stay, thrombosis, and antibiotic prophylaxis. Guideline rationale was reviewed in terms of mortality and thromboembolism rate. RESULTS: Sixty-four percent of the interventions were performed in a timely manner. Thrombosis prophylaxis was given in 99% of cases. Antibiotics were given as a single shot. There was no connection between mortality and thromboembolism rates or time to surgery. CONCLUSION[UBERSCHRIFT]: Guideline compliance is similar in German and Scotland. The external quality assurance data are suitable for evaluating guideline compliance. The literature recommends a short time to surgery. Given the short observation period, it was not possible to demonstrate any improvement in outcomes.

PMID: 18239903 [PubMed - as supplied by publisher]

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