Improved survival after an out-of-hospital cardiac arrest using new guidelines.

Acta Anaesthesiol Scand. 2008 May 12;

Authors: Steinmetz J, Barnung S, Nielsen SL, Risom M, Rasmussen LS

Background: An out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. We hypothesized that the implementations of 2005 European Resuscitation Council resuscitation guidelines were associated with improved 30-day survival after OHCA. Methods: We prospectively recorded data on all patients with OHCA treated by the Mobile Emergency Care Unit of Copenhagen in two periods: 1 June 2004 until 31 August 2005 (before implementation) and 1 January 2006 until 31 March 2007 (after implementation), separated by a 4-month period in which the above-mentioned change took place. Results: We found that 30-day survival increased after the implementation from 31/372 (8.3%) to 67/419 (16%), P=0.001. ROSC at hospital admission, as well as survival to hospital discharge, were obtained in a significantly higher proportion from 23.4% to 39.1%, P

PMID: 18477076 [PubMed - as supplied by publisher]

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The diagnostic work up of growth failure in secondary health care; an evaluation of consensus guidelines.

BMC Pediatr. 2008 May 13;8(1):21

Authors: Grote FK, Oostdijk W, De Muinck Keizer-Schrama SM, van Dommelen P, van Buuren S, Dekker FW, Ketel AG, Moll HA, Wit JM

ABSTRACT: BACKGROUND: As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we assess how many children are correctly referred to secondary health care according to existing consensus guidelines, evaluate the diagnostic work-up in secondary health care and study the frequency of underlying medical disorders. METHODS: Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC – Sophia Children’s Hospital, Rotterdam and Spaarne Hospital, Haarlem) between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG) is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine whether children were correctly referred or not and on all elements of the diagnostic work up. RESULTS: Of children older than 3 years 76% was correctly referred (CR). 74-88% of these children were short corrected for parental height, 40-61% had a height SDS

PMID: 18477383 [PubMed - as supplied by publisher]

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HER-2/neu Assessment in Breast Cancer Using the Original FDA and New ASCO/CAP Guideline Recommendations: Impact on Selecting Patients for Herceptin Therapy.

Am J Clin Pathol. 2008 Jun;129(6):907-11

Authors: Brunelli M, Manfrin E, Martignoni G, Bersani S, Remo A, Reghellin D, Chilosi M, Bonetti F

We evaluated HER-2/neu status in 100 consecutive ductal breast carcinomas by using the Food and Drug Administration (FDA) and American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) scoring systems. With the FDA system, scores were 3+ in 23.0%, 2+ in 25.0%, and 0 or 1+ in 52.0% of cases. With the ASCO/CAP system, scores were 3+ in 16.0%, 2+ in 34.0%, and 0 or 1+ in 50.0%. With the FDA and ASCO/CAP systems, respectively, 3+ cases (n = 23 and 16, respectively) showed high-grade, granular HER-2/neu amplification in 15 (65%) and 14 (88%); low-grade, borderline amplification in 7 (30%) and 1 (6%); and chromosome 17 polysomy without amplification in 1 (4%) and 1 (6%).Concordance between schemes was higher for cases with high-grade, granular HER-2/neu amplification (concordance coefficient, 0.74). Cases with low-grade, borderline HER-2/neu amplification showed poor concordance (concordance coefficient, 0.20).The FDA and ASCO/CAP schemes for HER-2/neu evaluation select patients differently for trastuzumab therapy. Major discordance is present for low-grade, borderline HER-2/neu amplification. FDA low-grade, borderline tumors would be reclassified as without HER-2/neu amplification or as polysomic. The ASCO/CAP scheme has a great concordance coefficient between strong 3+ immunohistochemical cases and cases with high-grade, granular HER-2/neu amplification.

PMID: 18480007 [PubMed - in process]

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Physician characteristics and the reported effect of evidence-based practice guidelines.

Health Serv Res. 2008 Apr;43(2):569-81

Authors: Sammer CE, Lykens K, Singh KP

OBJECTIVE: To explore characteristics that may contribute to the effect practice guidelines have on the practice of medicine. DATA SOURCES: From the third round of the Community Tracking Study, Physician Survey, 2000-2001. STUDY DESIGN: An ordinal logistic regression model was estimated to capture the full range of responses. PRINCIPAL FINDINGS: Recent medical school graduates, women, minorities, ob-gyn specialists, physicians who use computers for information in their practices, and physicians in nonsolo practice types were significantly more likely to state practice guidelines had an effect on their practice. CONCLUSIONS: Many barriers have prevented wide acceptance of practice guidelines among the medical community. Our findings suggest there will be positive results on guideline effects as recent graduates, women, and minorities enter the physician workforce.

PMID: 18484106 [PubMed - indexed for MEDLINE]

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Poor adherence to HIV monitoring and treatment guidelines for HIV-infected injection drug users.

HIV Med. 2008 May 13;

Authors: Wood E, Kerr T, Zhang R, Guillemi S, Palepu A, Hogg R, Montaner J

Objectives There is growing concern about access to HIV/AIDS care among injection drug users (IDUs). We examined rates of CD4 cell count monitoring and correlates among HIV-infected IDUs. Methods This prospective observational cohort study of 460 community-recruited HIV-infected IDUs was situated in a Canadian city where all medical care is provided free of charge. Over a median follow-up period of 76 months, we evaluated factors associated with CD4 cell count monitoring through a linkage with a centralized CD4 registry. Results Overall,

PMID: 18484977 [PubMed - as supplied by publisher]

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Nurses’ perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore Hospitals.

BMC Health Serv Res. 2008 May 18;8(1):105

Authors: Koh SS, Manias E, Hutchinson AM, Donath S, Johnston L

ABSTRACT: BACKGROUND: Theories of behaviour change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses’ opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore. METHODS: Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, ‘Barriers and facilitators assessment instrument’, was administered to nurses (n=1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore. RESULTS: An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and education of staff and patients. CONCLUSIONS: Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.

PMID: 18485235 [PubMed - as supplied by publisher]

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An automated method for analyzing adherence to therapeutic guidelines: Application in Diabetes.

Stud Health Technol Inform. 2008;136:339-44

Authors: Toussi M, Ebrahiminia V, Le Toumelin P, Cohen R, Venot A

Background: Physicians’ adherence to guidelines can be used for measuring prescribing appropriateness. We present a simple approach allowing the automation of this process. Design: The drug therapy is described in terms of treatment type, pharmacotherapeutic classes, international non proprietary names (INN) and doses. A rule-based engine implementing the guideline generates recommendations for each patient record. These are automatically compared with prescriptions of the same patient in three levels of detail. Participants: Ambulatory patients admitted for the follow-up of their type 2 diabetes between June 2003 and September 2004 in a university hospital in France. Results: For 574 patient records included in the study, physicians agreed with the guideline recommendations over the choice of type of treatment in 473 cases (82%). When agreement over pharmacotherapeutic class of drugs was also taken into account, the adherence ratio decreased to 448 cases (78%). Finally, when the dosage of each drug was taken into account, the adherence ratio dropped to 396 cases (69%). Adherence ratios were also dependent on the type of treatment at admission: low for patients on oral tritherapy, and on diet and exercise. The results also highlighted inertia of physicians for beginning drug therapy and the underuse of biguanides. Conclusions: The proposed method provides an automatable way of measuring the appropriateness of treatment choice, which can be used for chronic diseases.

PMID: 18487754 [PubMed - in process]

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Systematic review and evidence-based consensus guideline on prevention of allergy and atopic eczema of the German Network on Allergy Prevention (ABAP).

Minerva Pediatr. 2008 Jun;60(3):313-25

Authors: Schäfer T, Borowski C, Reese I, Werfel T, Gieler U

Allergies are a meaningful public-health problem. Until now no evidence-based recommendations for allergy prevention exist. An evidence based guideline for primary and secondary prevention of allergies was developed in the course of the German Network on Allergy Prevention (Aktionsbündnis Allergiepräven-tion, ABAP) with support of the German Ministry of Health. Results of the systematic evidence search and the consented recommendations are presented here. After an appropriate search strategy was developed, a systematic literature search was performed in electronic databases (Cochrane library, MEDLINE, EMBASE). Furthermore four selected journals were hand-searched and reference lists of actual reviews as well as grey literature was screened. Some 3 500 references were retrieved initially and a two-stage filter process on the relevance was applied by screening titles and abstracts and subsequently full-text papers. For the critical methodological appraisal modifications of international checklists were used. A total of 323 studies were included and evaluated. These comprised 3 Cochrane Reviews, 7 meta-analyses, 37 randomized controlled trials (RCTs) as well as 102 cohort and 174 case-control-studies. The following levels of evidence were applied: 3x1a, 21x1b, 5x2a, 59x2b, 1x3a, 45x3b, 189×4. These studies were summarized in a form of a systematic review and corresponding recommendations were formulated. The latter were consented by members of the abap steering committee in two consensus meeting where the method of a nominal group process was applied. For the first time recommendations for the prevention of allergies were developed on a high methodological standard. The content and modifications reflect the existing evidence.

PMID: 18487977 [PubMed - in process]

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Guidelines for Conducting Pharmaceutical Budget Impact Analyses for Submission to Public Drug Plans in Canada.

Pharmacoeconomics. 2008;26(6):477-495

Authors: Marshall DA, Douglas PR, Drummond MF, Torrance GW, Macleod S, Manti O, Cheruvu L, Corvari R

Until now, there has been no standardized method of performing and presenting budget impact analyses (BIAs) in Canada. Nevertheless, most drug plan managers have been requiring this economic data to inform drug reimbursement decisions. This paper describes the process used to develop the Canadian BIA Guidelines; describes the Guidelines themselves, including the model template; and compares this guidance with other guidance on BIAs. The intended audience includes those who develop, submit or use BIA models, and drug plan managers who evaluate BIA submissions.The Patented Medicine Prices Review Board (PMPRB) initiated the development of the Canadian BIA Guidelines on behalf of the National Prescription Drug Utilisation Information System (NPDUIS). The findings and recommendations from a needs assessment with respect to BIA submissions were reviewed to inform guideline development. In addition, a literature review was performed to identify existing BIA guidance. The detailed guidance was developed on this basis, and with the input of the NPDUIS Advisory Committee, including drug plan managers from multiple provinces in Canada and a representative from the Canadian Agency for Drugs and Technologies in Health. A Microsoft((R)) Excel-based interactive model template was designed to support BIA model development. Input regarding the guidelines and model template was sought from each NPDUIS Advisory Committee member to ensure compatibility with existing drug plan needs. Decisions were made by consensus through multiple rounds of review and discussion. Finally, BIA guidance in Canadian provinces and other countries were compared on the basis of multiple criteria.The BIA guidelines consist of three major sections: Analytic Framework, Inputs and Data Sources, and Reporting Format. The Analytic Framework section contains a discussion of nine general issues surrounding BIAs (model design, analytic perspective, time horizon, target population, costing, scenarios to be compared, the characterisation of uncertainty, discounting, and validation methods). The Inputs and Data Sources section addresses methods for market size estimation, comparator selection, scenario forecasting and drug price estimation. The Reporting Format section describes methods for BIA reporting.The new Canadian BIA Guidelines represent a significant departure from the limited guidance that was previously available from some of the provinces, because they include specific details of the methods of performing BIAs. The Canadian BIA Guidelines differ from the Principles of Good Research Practice for BIAs developed by the International Society for Pharmacoeconomic and Outcomes Research (ISPOR), which provide more general guidance.The Canadian BIA Guidelines and template build upon existing guidance to address the specific requirements of each of the participating drug plans in Canada. Both have been endorsed by the NPDUIS Steering Committee and the PMPRB for the standardization of BIA submissions.

PMID: 18489199 [PubMed - as supplied by publisher]

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Scientific Guidelines and Their Implementation in Health Policy.

Value Health. 2008 May 16;

Authors: von der Schulenburg JM, Mittendorf T, Vauth C, Greiner W

PMID: 18489512 [PubMed - as supplied by publisher]

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