Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline.

J Clin Endocrinol Metab. 2008 Feb 5;

Authors: Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA

Objective: To develop clinician practice guidelines for the evaluation and treatment of hirsutism in premenopausal women. Participants: The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, two methodologists, and a medical writer. The Task Force received no corporate funding or remuneration. Evidence: Systematic reviews of available evidence were used to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) group criteria to describe both the quality of evidence and the strength of recommendations. We used ‘recommend’ for strong recommendations, and ‘suggest’ for weak recommendations. Consensus Process: Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and e-mail communications. The drafts prepared by the task force with the help of a medical writer were reviewed successively by The Endocrine Society’s CGS, Clinical Affairs Committee (CAC), and Council. The version approved by the CGS and CAC was placed on The Endocrine Society’s Web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes. Conclusions: We suggest testing for elevated androgen levels in women with moderate or severe hirsutism, or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction, obesity, or clitoromegaly. For women with patient-important hirsutism despite cosmetic measures, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For women who choose hair removal therapy, we suggest laser/photoepilation.

PMID: 18252793 [PubMed - as supplied by publisher]

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[Short version of the updated S3 (level 3) guidelines for diagnosis and treatment of gallstones of the German Society for Digestive and Metabolic Diseases and the German Society for the Surgery of the Alimentary Tract]

Dtsch Med Wochenschr. 2008 Feb;133(7):311-6

Authors: Lammert F, Neubrand MW, Bittner R, Feussner H, Greiner L, Hagenmüller F, Kiehne KH, Ludwig K, Neuhaus H, Paumgartner G, Riemann JF, Sauerbruch T, ,

This short version of the guidelines summarizes the evidence-based key recommendations for the diagnosis and treatment of gallstones. The guidelines were developed by an interdisciplinary team of gastroenterologists, surgeons, radiologists, geneticists, and patient support groups, under the auspice of the German Society for Gastroenterology and Metabolic Diseases and the German Society for General Surgery and Surgery of the Alimentary Tract. It used structural level 3 consensus-based methodology and includes statements on clinical practice, prevention, quality assurance, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone disease.

PMID: 18253923 [PubMed - indexed for MEDLINE]

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Withholding and withdrawing dialysis in the intensive care unit: benefits derived from consulting the renal physicians association/american society of nephrology clinical practice guideline, shared decision-making in the appropriate initiation of and withdrawal from dialysis.

Clin J Am Soc Nephrol. 2008 Mar;3(2):587-93

Authors: Patel SS, Holley JL

Despite advances in the technology of dialysis, mortality in patients who develop acute renal failure remains high. Scoring systems have been developed to improve the ability to define prognosis in seriously ill patients with acute renal failure but predicting outcomes for individual patients is uncertain. Decisions to withhold or withdraw dialysis in seriously ill patients are difficult for patients, families, and health care providers. The clinical practice guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis, provides evidence-based recommendations to aid nephrologists in discussions and the process of medical decision-making about starting and stopping dialysis. Estimating prognosis and addressing the issues of advance directives and patient and family preferences through the process of shared decision-making can clarify appropriate strategies for clinical management and interventions. Time-limited trials of dialysis may be an invaluable tool in this process. Increasing nephrologists’ awareness of the guideline may facilitate decision-making around the issues of withholding and withdrawing dialysis in part by clarifying patients and situations in which it may be appropriate to withhold or withdraw dialysis.

PMID: 18256375 [PubMed - in process]

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Effect of a CD-ROM-based educational intervention on resident knowledge and adherence to deep venous thrombosis prophylaxis guidelines.

J Hosp Med. 2008 Jan;3(1):42-7

Authors: Baskin C, Seetharamu N, Mazure B, Vassallo L, Steinberg H, Kerpen H, Mattana J

BACKGROUND: CD-ROM-based educational methods are not new to residency training, yet little is known about how they affect resident knowledge and patient care practices. OBJECTIVE: We evaluated the effects of a CD-ROM-based educational tool on residents’ knowledge of anticoagulation and their adherence to anticoagulation guidelines. DESIGN, SETTING AND PARTICIPANTS: Residents in the departments of cardiothoracic surgery, emergency medicine, otolaryngology, internal medicine, neurosurgery, dental medicine, neurology, obstetrics and gynecology, orthopedics, surgery, and urology at a university hospital participated in the study. INTERVENTION: Residents were provided with CD-ROM-based training on the proper use of anticoagulation based on the sixth ACCP guidelines for antithrombotic therapy. Multiple choice testing was carried out before and after the CD-ROM intervention to assess resident knowledge, and resident compliance with venous thromboembolism prophylaxis guidelines was assessed via inpatient chart review by an independent committee. MAIN OUTCOME MEASURES: Changes in knowledge were measured via test scores and the rate of compliance with anticoagulation guidelines. RESULTS: Multiple choice test scores of 117 residents increased significantly after reviewing the CD-ROM (from 46.7% +/- 15.1% to 77.8% +/- 15.1%, P

PMID: 18257045 [PubMed - in process]

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[Practice guidelines and accreditation: highlights from 50 years of quality management by the Dutch College of General Practitioners]

Ned Tijdschr Geneeskd. 2007 Dec 29;151(52):2916-9

Authors: in ‘t Veld CJ, Grol RP

The Dutch College of General Practitioners (NHG) was established 50 years ago in response to the threatened position of general practitioners in The Netherlands. The NHG promotes quality care in general practice by aiding in the translation of scientific evidence into daily practice. The NHG practice guidelines form the core of its quality improvement programme, which comprises a cohesive package of continuing educational materials that support adoption in daily practice. The NHG practice accreditation programme is a new method for measuring and improving practice quality. This programme provides the basis for granting stamps of quality to general practices.

PMID: 18257441 [PubMed - indexed for MEDLINE]

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Acceptance and perceived barriers of implementing a guideline for managing low back in general practice.

Implement Sci. 2008 Feb 7;3(1):7

Authors: Chenot JF, Scherer M, Becker A, Donner-Banzhoff N, Baum E, Leonhardt C, Keller S, Pfingsten M, Hildebrandt J, Basler HD, Kochen MM

ABSTRACT: BACKGROUND: Implementation of guidelines in clinical practice is difficult. In 2003, the German College of General Practitioners and Family Physicians (DEGAM) released an evidence-based guideline for the management of low back pain (LBP) in primary care. The objective of this study is to explore the acceptance of guideline content and perceived barriers to implementation. METHODS: Seventy-two general practitioners (GPs) participating in quality circles within the framework of an educational intervention study for guideline implementation evaluated the LBPguideline and its practicability with a standardised questionnaire. In addition, statements of group discussions were recorded using the metaplan technique and were incorporated in the discussion. RESULTS: Most GPs agree with the guideline content but believe that guideline stipulations are not congruent with patient wishes. Non-adherence to the guideline and contradictory information for patients by other professionals (e.g., GPs, orthopaedic surgeons, physiotherapists) are important barriers to guideline adherence. Almost half of the GPs have no access to recommended multimodal pain programs for patients with chronic LBP. CONCLUSIONS: Promoting adherence to the LBP guideline requires more than enhancing knowledge about evidence-based management of LBP. Public education and an interdisciplinary consensus are important requirements for successful guideline implementation into daily practice. Guideline recommendations need to be adapted to the infrastructure of the health care system. Trial registration BMBF Grant Nr. 01EM0113. FORIS [database for research projects in social science (www.gesis.org/Information/FORIS/Recherche/index.htm)] Reg #: 20040116.

PMID: 18257923 [PubMed - as supplied by publisher]

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European guidelines for the diagnosis and treatment of pelvic girdle pain.

Eur Spine J. 2008 Feb 8;

Authors: Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B

A guideline on pelvic girdle pain (PGP) was developed by “Working Group 4″ within the framework of the COST ACTION B13 “Low back pain: guidelines for its management”, issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick’s Faber, Gaenslen’s test, and modified Trendelenburg’s test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP.

PMID: 18259783 [PubMed - as supplied by publisher]

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Current guidelines on management of HIV-infected pregnant women: Impact on mode of delivery.

Eur J Obstet Gynecol Reprod Biol. 2008 Feb 7;

Authors: Suy A, Hernandez S, Thorne C, Lonca M, Lopez M, Coll O

OBJECTIVE: To evaluate acceptance, feasibility and difficulties in the application of a policy of vaginal delivery in selected cases in HIV-infected women. STUDY DESIGN: HIV-infected women delivering March 2002 to December 2004 and enrolled in a prospective observational study in a University hospital tertiary care center were included. A vaginal delivery was not considered if labor before 36 weeks of pregnancy, preterm premature rupture of membranes, on non-highly active antiretroviral therapy (HAART) or viral load >1000copies/mL. Main outcome measures were mode of delivery, prematurity, acceptance of vaginal delivery and mother-to-child transmission of HIV infection. RESULTS: The study included 91 pregnancies, with a total of 95 fetuses. Eighty percent (n=73) of women knew their HIV infection status before becoming pregnant and 57 (63%) were on HAART at conception. Median gestational age at delivery was 37 weeks (range 22-41). Twelve women delivered a live-born before 36 weeks, all with a caesarean section. Among 74 women who reached 36 weeks gestation, 47 (64%) met the pre-established criteria for vaginal delivery, of whom 21 (45%) delivered vaginally. The most common reason for not having a vaginal delivery was the woman’s request for a caesarean section. No cases of HIV vertical transmission occurred (0/90, 95% CI 0-4.02%). CONCLUSION: Recommending vaginal delivery among HIV-infected women in selected cases was well accepted, particularly once the policy became established. Nevertheless, a high proportion of HIV-infected women will continue to require caesarean section delivery.

PMID: 18262324 [PubMed - as supplied by publisher]

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[Guidelines in mass disaster victims identification through the Tsunami experience (December 26, 2004)]

Rev Med Brux. 2007 Nov-Dec;28(6):512-22

Authors: Beauthier JP, Lefèvre P

The adequate management of a victim’s identification must go through an essential rigour in the applied methodology. This is all the more necessary when you face a mass disaster such as the Tsunami of December 26, 2004. We will explain in this presentation how the DVI Belgian Team, in close collaboration with the other International Teams, proceeded in January 2005, adopting real guidelines, in strict accordance with the Interpol fixed ones. We will review the various stages of our work, paying special attention to the fingerprints, the examination of clothes, jewels and specific objects, but also to the external and internal examinations of the corpses, the odontological and anthropological approaches and the systematic DNA samplings. Both rigour and application of the Interpol international conventions allow such a systematic approach. Only this optimal procedure can guarantee the best identifications of numerous victims.

PMID: 18265810 [PubMed - in process]

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World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Substance Use and Related Disorders, Part 1: Alcoholism.

World J Biol Psychiatry. 2008;9(1):6-23

Authors: Soyka M, Kranzler HR, Berglund M, Gorelick D, Hesselbrock V, Johnson BA, Möller HJ, Disorders TW

These practice guidelines for the biological treatment of substance use disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of substance use disorders, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by physicians evaluating and treating people with substance use disorders and are primarily concerned with the biological treatment of adults suffering from substance use disorders. The data used to develop these guidelines were extracted primarily from various national treatment guidelines for substance use disorders, as well as from meta-analyses, reviews and randomized clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorized into four levels of evidence (A-D). This first part of the guidelines covers the treatment of alcohol dependence; Part 2 will be devoted to the treatment of drug dependence.

PMID: 18273737 [PubMed - in process]

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