The clinical database and the treatment guidelines of the Danish Breast Cancer Cooperative Group (DBCG); its 30-years experience and future promise.

Acta Oncol. 2008;47(4):506-24

Authors: Møller S, Jensen MB, Ejlertsen B, Bjerre KD, Larsen M, Hansen HB, Christiansen P, Mouridsen HT,

Introduction. Since 30 years, DBCG (Danish Breast Cancer Cooperative Group) has maintained a clinical database allowing the conduct of quality control studies, of randomised trials, examination of the epidemiology of breast cancer and of prognostic and predictive factors. Material and methods. The original database included patients with invasive breast cancer, but has later been expanded to patients with in situ breast cancer and hereditary breast and ovarian cancer families. Results. The multidisciplinary cooperative group has provided successive treatment guidelines and 70% of the 77284 registered patients have been enrolled and received treatment according to these guidelines. The standard treatments and the randomised trials included in the DBCG programmes are all briefly described. Among high-risk patients 48% have participated in randomised trials, and the results of these trials have largely been implemented in the next generation of treatment guidelines. Records within the clinical database of archival tumour tissue have established a basis for translational research and epidemiologic research has been enabled through linkage to other healthcare registries. Discussion. The joint conception of the multidisciplinary breast cancer group and a clinical database has provided improvements in the management of breast cancer patients and has enabled recruitment of patients onto randomised trials.

PMID: 18465317 [PubMed - in process]

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Charting the possible impact of national guidelines on the management of rheumatoid arthritis.

Scand J Rheumatol. 2008 May-Jun;37(3):188-93

Authors: Carli C, Bridges JF, Ask J, Lindblad S

Objective: To identify temporal trends in the prescription of disease-modifying antirheumatic drugs (DMARDs) in patients with early rheumatoid arthritis (RA). Methods: Using data from the Swedish RA register (n = 2584), we analysed the proportion of RA patients prescribed DMARDs at their first consultation between 1997 and 2001. Statistical process control (SPC) was used to chart and analyse major changes in prescription behaviour, while more traditional time series analysis methods (i.e. regression) were used to corroborate the nature of any trend. Results: The SPC method identified an upward shift in the prescription of DMARDs in July 1998 and a change in the process by October 1998. Time series analysis confirmed an increasing trend in DMARD prescription over the period as a whole and the trend was statistically significant (p

PMID: 18465453 [PubMed - in process]

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[Intensive care nurses' knowledge about the evidence-based guidelines of preventing centralvenous catheter related infection.]

Orv Hetil. 2008 May 18;149(20):929-34

Authors: Csomós A, Orbán E, Konczné Réti R, Vass E, Darvas K

Objectives: To determine intensive care unit (ICU) nurses’ knowledge of evidence-based guidelines for preventing central venous catheter (CVC) related infection. Method: We used a validated multiple-choice questionnaire which was distributed to intensive care units between October and December 2006. We collected demographic data, like gender, years of ICU experience, number of ICU beds and whether respondents hold a special degree in intensive care. Results: We collected 178 questionnaires from 11 intensive care units; the mean score was 3.66 on 10 questions (37%). Eighteen per cent knew that CVCs should be replaced on indication only, and 61% knew that this recommendation concerns also replacement over a guidewire. Recommendations for replacing pressure transducers and tubing every 4 days, and for using coated devices in patients requiring a CVC

PMID: 18467262 [PubMed - in process]

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IGG practice guidelines on germ cell tumor in adult male patients.

Tumori. 2008 Jan-Feb;94(1):96-109

Authors: De Giorgi U, Nicolai N, Tana S, Tavolini IM, Palazzi S, Bracarda S, Tedeschi L, Palmieri G, Frassineti L, Da Pozzo L, Pastorino U, Emiliani E, Marangolo M, Pizzocaro G, Rosti G, Salvioni R,

Germ cell tumors are rare neoplasms that affect young males. Nearly 99% of patients with localized stage I disease and nearly 80% of patients with metastatic disease can be cured. Even patients who relapse following chemotherapy can achieve a long-term survival in approximately 30-40% of cases. The main objective in early stages and in good prognosis patients has changed in recent years, and it has become of major importance to reduce treatment-related morbidity without compromising the excellent long-term survival rate. In poor prognosis patients, there is a correlation between the experience of the treating institution and the long-term clinical outcome of the patients, particularly when the most sophisticated therapies are needed. So far, of utmost importance is the information from updated practice guidelines for the diagnosis and treatment of germ cell tumors. The Italian Germ cell cancer Group (IGG) has developed the following clinical recommendations, which identify the current standards in diagnosis and treatment of germ cell tumors in adult males.

PMID: 18468343 [PubMed - in process]

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European best practice quo vadis? From European best practice guidelines (EBPG) to European renal best practice (ERBP).

Nephrol Dial Transplant. 2008 May 9;

Authors: Zoccali C, Abramowicz D, Cannata-Andia JB, Cochat P, Covic A, Eckardt KU, Fouque D, Heimburger O, McLeod A, Lindley E, Locatelli F, Spasovski G, Tattersall J, Biesen WV, Wanner C, Vanholder R

PMID: 18469309 [PubMed - as supplied by publisher]

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Wastewater irrigation of salad crops: further evidence for the evaluation of the WHO guidelines.

Water Sci Technol. 2008;57(8):1213-1219

Authors: Bastos RK, Bevilacqua PD, Silva CA, Silva CV

This paper presents the results of an experiment on salad crop irrigation with waste stabilisation pond effluents, conducted in Southeast Brazil. Over about 18 months several trials were carried out using different effluent qualities to irrigate lettuce, kale, arugula, spinach, and green pepper. Equations for predicting the bacterial quality of irrigated crops (E.coli per gram) based on the irrigation water quality (E.coli per 100 mL) were derived for low and high growing crops. The quantitative microbial risk analysis (QMRA) technique, using pathogen-ingestion scenarios based on these field data and on official statistics of vegetables consumption in Brazil, was used to estimate infection risks arising from the consumption of wastewater irrigated crops. It is inferred that irrigation with effluents complying with the WHO guidelines for unrestricted irrigation should result in salad crops acceptable for consumption.

PMID: 18469392 [PubMed - as supplied by publisher]

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Implementing clinical guidelines for self harm – highlighting key issues arising from the NICE Guideline for self-harm.

Psychol Psychother. 2008 May 8;

Authors: Pitman A, Tyrer P

The NICE clinical guideline on self-harm has been criticized for its reliance on expert consensus view in the absence of evidence on psychological aspects of care. The relative dearth of published experiences in implementing these guidelines is a likely consequence of these doubts. This article highlights the methodological problems inherent to the development of guidelines covering the first 48 hours after a presentation of self-harm, and reviews four areas where implementation has advanced: change in staff attitudes; triage scales; psychosocial assessments; and specific interventions for borderline personality disorder (BPD). Suggestions are made for how future versions of the guidelines might be adapted to improve the process of referral for appropriate psychological care and to provide more equitable access to care for patients in distress.

PMID: 18471348 [PubMed - as supplied by publisher]

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[Adherece of Nursing Graduation Courses to the National Curricular Guidelines]

Rev Bras Enferm. 2007 Nov-Dec;60(6):627-34

Authors: Lopes Neto D, Teixeira E, Vale EG, Cunha FS, Xavier Ide M, Fernandes JD, Shiratori K, Reibnitz KS, de Sordi MR, Barbieri M, Bocardi MI

The objective of this study was to evaluate the adherence of the Pedagogic Projects of Nursing Graduation Courses (PPC/ENF) to the National Guidelines for the Curriculum of Nursing Graduation Courses (DCN/ENF). It was a descriptive study that compared the information obtained from the reports of the PPC/ENF and the proposals of DCN/ENF, using data collected by INEP/MEC and made available for this study. The data base consisted of all reports from 110 nursing graduation courses that were seeking accreditation or renewal between 2002 and 2006. Sixty aspects of the evaluation were selected and 10. The study reports that the rate of adherence of the nursing courses to the DCN/ENF guidelines was low, 72%. These findings indicate there is a need for nursing courses/schools to adjust the epistemological bases of the DCN/ENF to the proposals of PPC/ENF.

PMID: 18472533 [PubMed - in process]

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Leiden reconstructed human epidermal model as a tool for the evaluation of the skin corrosion and irritation potential according to the ECVAM guidelines.

Toxicol In Vitro. 2008 Apr 7;

Authors: El Ghalbzouri A, Siamari R, Willemze R, Ponec M

In the ECVAM validation studies two common skin protocols have been developed, the skin corrosion and skin irritation protocol. Both protocols include next to general and functional conditions that the skin model must meet, also the correct prediction of the activity of certain reference chemicals. For the skin corrosion protocol, the OECD TG 431 defined 12 reference chemicals that should be correctly predicted by the epidermal skin model. For skin irritation 20 test substances should meet the defined criteria. In this study we aimed to subject our Leiden human epidermal (LHE) model to both common protocols according to the ECVAM guidelines. The LHE model generated in this study has been fully characterized and shows very high similarities with the native skin. After minor technical changes in both protocols, corrosion classifications were obtained in concordance with those reported for the validated human skin models EpiSkintrade mark and EpiDermtrade mark. The results obtained with the common skin irritation protocol were very similar to that of earlier studies with the SkinEthic, EpiSkin(TM) and EpiDerm(TM) models. This means that the protocols and prediction models developed during the validation studies with a specific skin model can be used with other similar skin models. This study demonstrates that reconstructed human skin equivalents have been proven to be efficient and reliable alternatives to animal testing.

PMID: 18474418 [PubMed - as supplied by publisher]

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Diabetes flow sheet use associated with guideline adherence.

Ann Fam Med. 2008 May-Jun;6(3):235-8

Authors: Hahn KA, Ferrante JM, Crosson JC, Hudson SV, Crabtree BF

PURPOSE: Many intervention studies have found that flow sheet use improves patient care by drawing attention to a particular medical condition or needed preventive service and encouraging an immediate response from the health care professional; however, there are no studies examining how often flow sheets are used for diabetes in primary care practice. We assessed the relationship between diabetes flow sheet use and diabetes patient care outcomes in the everyday practice of primary care. METHODS: We abstracted the medical records of 1,016 patients with diabetes seen at 54 New Jersey and eastern Pennsylvania family practices participating in a quality improvement trial. The use of diabetes flow sheets was noted for each medical record. Scores for adherence to evidence-based diabetes guidelines in terms of assessment, treatment, and target attainment were determined on 100-point scales, with higher scores indicating better adherence. Generalized linear models were used to determine associations between use of diabetes flow sheets and adherence to guidelines. RESULTS: Diabetes flow sheets were used in 23% of the medical records of patients with diabetes. Use of flow sheets was associated with better mean guideline adherence scores for the assessment of diabetes (55.38 vs 50.13, P = .02) and the treatment of diabetes (79.59 vs 74.71, P = .004), but not for the attainment of intermediate diabetes outcome targets (hemoglobin A(1c) level, low-density lipoprotein cholesterol level, and blood pressure). CONCLUSIONS: Diabetes flow sheets can be used to promote better adherence to guidelines when it comes to assessing and treating diabetes. Additional research is needed to explore patient and physician variables that mediate the relationship between use of diabetes flow sheets and intermediate outcome targets for diabetes.

PMID: 18474886 [PubMed - in process]

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