Dyslipidemia: the role of the hospitalist in guideline adherence and in-hospital initiation of therapy.

Crit Pathw Cardiol. 2004 Sep;3(3 Suppl):S20-2

Authors:

PMID: 18340165 [PubMed - in process]

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National cholesterol education program guidelines and supporting evidence.

Crit Pathw Cardiol. 2004 Sep;3(3 Suppl):S8-S11

Authors: McKenney JE

PMID: 18340168 [PubMed - in process]

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Assessment of Compliance With the American College of Cardiology/American Heart Association Guidelines for Patients With Acute Coronary Syndromes Admitted to a Tertiary Care Hospital Coronary Care Unit.

Crit Pathw Cardiol. 2002 Mar;1(1):22-25

Authors: Sharayeva ML, Tcheng JE, Cannon CP

PMID: 18340286 [PubMed - as supplied by publisher]

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Assessing the Effect of Publication of Clinical Guidelines on the Management of Unstable Angina and Non-ST Elevation Myocardial Infarction in The TIMI III (1990-1993) and the GUARANTEE (1995-1996) Registries.

Crit Pathw Cardiol. 2002 Sep;1(3):150-158

Authors: Scirica BM, Cannon CP, Gibson CM, Murphy SA, Moliterno DJ, Anderson HV, Aguirre FV, Granger CB, Lambrew CT, Rabbani LE, Sapp SK, Booth JE, Ferguson JJ, Braunwald E

BACKGROUND: The clinical guidelines for unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) published in 1994 by the Agency for Health Care Policy Research (AHCPR) were intended to help improve treatment. No large study, however, has evaluated the effect of the guidelines on clinical practice METHODS: We compared the treatment of 3,318 patients admitted with UA/NSTEMI in the preguideline Thrombolysis in Myocardial Infarction (TIMI) III Registry (1990-1993) and 2,948 patients enrolled in the postguideline Global Unstable Angina Registry and Treatment Evaluation (GUARANTEE) Registry (1995-1996). RESULTS: More patients in GUARANTEE received guideline-recommended medication than did those in TIMI III, specifically beta-blockers (50.9% vs. 40.7%, P

PMID: 18340298 [PubMed - as supplied by publisher]

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Quality Improvement Tools Designed to Improve Adherence to the ACC/AHA Guidelines for the Care of Patients with Non-ST-Segment Acute Coronary Syndromes: The CRUSADE Quality Improvement Initiative.

Crit Pathw Cardiol. 2003 Mar;2(1):34-40

Authors: Staman KL, Roe MT, Fraulo ES, Lytle BL, Gibler WB, Ohman EM, Peterson ED

PMID: 18340316 [PubMed - as supplied by publisher]

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Implications for Australian practice of North American guidelines for the support of the family in patient-centred intensive care.

Collegian. 2008;15(1):11-7

Authors: McKinley S, Elliott RM

Patient-centred care, in which health care professionals inform patients and families, maintain active involvement in decision making, coordinate care across disciplines, provide families with physical comfort and emotional support and ensure care is culturally sensitive, is recommended over clinician- or disease-centred care for better patient outcomes. Patients in intensive care are often too ill to participate in communication and decision making, so the patient’s family should be involved in communication and decision making about the patient’s care. The Society of Critical Care Medicine published clinical practice guidelines for the support of the family in the patient-centred intensive care unit. The purpose of this paper is to assess whether the 42 recommendations in the guidelines are valid and applicable in Australia. We used a recognised framework for evaluation of clinical practice guidelines. It was found that the guidelines were developed systematically using accepted methods of guideline development as much as possible. An extensive literature review was conducted and publications containing all levels of evidence were considered for inclusion. There were some weaknesses in the guideline development, especially lack of consultation with patients and families and a lack of high-level evidence, however the authors have provided comprehensive recommendations to guide all aspects of patient-centred care. We conclude that the recommendations are largely applicable to the patients and families receiving treatment and support within intensive care units in Australia. Where strong evidence is lacking, the recommendations should be a stimulus to conduct studies that test interventions that may benefit intensive care patients, their families, and intensive care staff.

PMID: 18341072 [PubMed - in process]

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Modelling the resource implications and budget impact of new reimbursement guidelines for the management of cow milk allergy in Finland.

Curr Med Res Opin. 2008 Mar 13;

Authors: Guest JF, Valovirta E

OBJECTIVE: To assess the impact of the decision by Kela (The Social Insurance Institution) to adopt guidelines for the management of food allergies in children, developed by the Finnish Medical Society Duodecim, as the basis for reimbursing clinical nutrition preparations for the treatment of cow milk allergy (CMA) in Finland. METHODS: A decision model was constructed using published clinical outcomes and clinician-derived resource utilisation estimates. The model was used to estimate the net resource implications and associated costs of Kela’s new policy for the annual cohort of 1443 new CMA sufferers over the first 6 months following referral to a specialist. The analysis was conducted from the perspective of Kela, patients and Finnish society. RESULTS: Kela’s new policy for reimbursing clinical nutrition preparations for the treatment of CMA is expected to increase healthcare resource use, including a 10% increase in the number of specialist visits over the first 6 months following referral. Consequently, Kela’s 6-monthly expenditure on 1443 new CMA sufferers following referral is expected to increase by 12% from euro889,389 to euro992,761. Additionally, parents’ costs are expected to increase by 10% and fathers’ absenteeism from work to increase by 11% within the first 6 months following referral. CONCLUSION: It is important to validate guidelines in clinical practice before their implementation. Within the limitations of our model, Kela’s new criteria for reimbursing clinical nutrition preparations for the treatment of CMA is expected to increase healthcare resource use in paediatric departments in public hospitals in Finland and increase costs to Kela, patients and Finnish society.

PMID: 18341760 [PubMed - as supplied by publisher]

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A Nationwide Survey Evaluating Adherence to Guidelines for Follow-up After Polypectomy or Treatment for Colorectal Cancer.

J Clin Gastroenterol. 2008 Mar 13;

Authors: Mulder SA, Ouwendijk RJ, van Leerdam ME, Nagengast FM, Kuipers EJ

BACKGROUND: Endoscopic follow-up (FU) in patients treated for colorectal adenomas or cancer (CRC) is intended to reduce the incidence of CRC. In the Dutch postpolypectomy guidelines, the FU interval is solely determined by the number of previous adenomas, whereas in other countries size and histology are also taken into account. Whether this difference in policy is also reflected in clinical practice is unknown. Furthermore, FU guidelines after CRC are not standardized in The Netherlands, even though national recommendations are available. GOAL: To assess the adherence to the current Dutch postpolypectomy guidelines and to evaluate the FU policy after CRC resection. STUDY: A survey was sent to all Gastrointestinal Departments in The Netherlands. The survey consisted of questions on logistic organization of FU, postpolypectomy FU intervals, and FU after CRC. RESULTS: The response rate was 85%. In contrast to the national guidelines, size and histology of the adenomas were often taken into account, leading to shortening of the FU interval. With respect to the CRC cases, 52% of the respondents advised shorter FU intervals than advised by the national recommendations. CONCLUSIONS: Despite recent Dutch postpolypectomy guidelines, clinicians incorporate histology and size into their clinical strategy. Either further education on the guidelines is needed, or the guidelines need to be reconsidered. Furthermore, evidence-based guidelines for FU after CRC should be formulated.

PMID: 18344890 [PubMed - as supplied by publisher]

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Guidelines for heart transplantation.

Neth Heart J. 2008 Mar;16(3):79-87

Authors: de Jonge N, Kirkels JH, Klöpping C, Lahpor JR, Caliskan K, Maat AP, Brügemann J, Erasmus ME, Klautz RJ, Verwey HF, Oomen A, Peels CH, Golüke AE, Nicastia D, Koole MA, Balk AH

Based on the changes in the field of heart transplantation and the treatment and prognosis of patients with heart failure, these updated guidelines were composed by a committee under the supervision of both the Netherlands Society of Cardiology and the Netherlands Association for Cardiothoracic surgery (NVVC and NVT).THE INDICATION FOR HEART TRANSPLANTATION IS DEFINED AS: ‘End-stage heart disease not remediable by more conservative measures’.CONTRAINDICATIONS ARE: irreversible pulmonary hypertension/elevated pulmonary vascular resistance; active systemic infection; active malignancy or history of malignancy with probability of recurrence; inability to comply with complex medical regimen; severe peripheral or cerebrovascular disease and irreversible dysfunction of another organ, including diseases that may limit prognosis after heart transplantation.Considering the difficulties in defining end-stage heart failure, estimating prognosis in the individual patient and the continuing evolution of available therapies, the present criteria are broadly defined. The final acceptance is done by the transplant team which has extensive knowledge of the treatment of patients with advanced heart failure on the one hand and thorough experience with heart transplantation and mechanical circulatory support on the other hand. (Neth Heart J 2008;16:79-87.).

PMID: 18345330 [PubMed - in process]

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[Development of national guidelines for depression.]

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Apr;51(4):451-7

Authors: Härter M, Klesse C, Bermejo I, Lelgemann M, Weinbrenner S, Ollenschläger G, Kopp I, Berger M

Depressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guidelinebased diagnostics and treatment in routine care.

PMID: 18345469 [PubMed - in process]

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