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[Guideline-adherent treatment for asthma.]

Internist (Berl). 2008 Nov;49(11):1311-9

Authors: Sieren M, Buhl R, Taube C

Asthma is a complex syndrome with numerous clinical phenotypes. An increase in prevalence is detectable worldwide. Efforts to optimize diagnosis and care of patients with asthma have led to the development of international and national guidelines. Besides preventive and non-pharmacological measures such as patient education and physical training, the guidelines particularly recommend standardized drug therapy. In the present article we summarize the recommended pharmacotherapy for patients with bronchial asthma.

PMID: 18841343 [PubMed - in process]

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Use of a time series design to test effectiveness of a theory-based intervention targeting adherence of health professionals to a clinical guideline.

Br J Health Psychol. 2008 Oct 11;

Authors: Hanbury A, Wallace L, Clark M

Objectives The aim of this study was to test the effectiveness of a theory of planned behaviour intervention to increase adherence of community mental health professionals to a national suicide prevention guideline Design Routinely collected audit adherence data from an intervention and control site were collected and analysed using time series analysis to test whether the intervention significantly increased adherence. The effects of a local and national event on adherence were also examined. Method A Theory of Planned Behaviour (TPB) questionnaire, developed from interview findings, was administered to the health professionals. Subjective norms were found to be the most significant predictor of intention to adhere to the guideline, and were targeted with an interactive educational intervention. Time series analysis applied to routinely collected audit adherence data was used to test intervention effectiveness. Results The TPB accounted for 58% of the variance in intention to adhere, with subjective norms the only significant predictor. The intervention did not significantly increase adherence; however, the national and local events were found to have significantly increased adherence. Conclusions The TPB was a useful framework for exploring barriers to adherence; however, this did not translate into an effective intervention. Future research should seek collaboration with local experts, and use this information in combination with the TPB, to develop interventions. Collaborative research with experts in pedagogy may also help to develop more effective interventions, particularly education-based interventions that require adult learning.

PMID: 18851769 [PubMed - as supplied by publisher]

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Clinical guideline for the evaluation and management of chronic insomnia in adults.

J Clin Sleep Med. 2008 Oct 15;4(5):487-504

Authors: Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M

Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician’s time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist. Unless otherwise stated, “insomnia” refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks.

PMID: 18853708 [PubMed - in process]

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A Review of Physical Activity Measures Used Among US Latinos: Guidelines for Developing Culturally Appropriate Measures.

Ann Behav Med. 2008 Oct;36(2):195-207

Authors: Martinez SM, Ainsworth BE, Elder JP

BACKGROUND: As the US population continues to grow and diversify, there is a need for progressive physical activity measurement and cross-cultural research. Studies suggest that US Latinos are among the most sedentary of ethnic groups compared to others; however, study findings may be biased given that some measures may not be culturally sensitive for assessing behaviors that are not characterized as leisure time physical activity. PURPOSE: The primary objective of this review was to identify and evaluate measures used to quantify physical activity among US Latinos. METHODS: A review of the literature was performed and studies examining levels of physical activity among Spanish and English speaking Latinos were documented. This process involved identifying existing guidelines for the purpose of culturally adapting and/or translating (into Spanish) physical activity measures for the Latino population. These guidelines were used as the minimal criteria for the evaluation of the 13 identified measures of physical activity. RESULTS: Of these 13 measures, four were available in English and nine were available in Spanish. One English measure met the guidelines for being culturally adapted for assessing physical activity among Latinos. There were no Spanish measures that met all the guidelines for physical activity assessment among Spanish-speaking Latinos. Lastly, the identified guidelines for developing culturally appropriate measures were improved to advance physical activity measurement among ethnic and cultural groups. CONCLUSION: Future research should merit the use of culturally appropriate guidelines to increase the understanding of physical activity patterns in the USA.

PMID: 18855091 [PubMed - in process]

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Evaluation of international treatment guidelines and prognostic tests for the treatment of early breast cancer.

Cancer Treat Rev. 2008 Oct 13;

Authors: Muñoz M, Estévez LG, Alvarez I, Fernández Y, Margelí M, Tusquets I, Seguí MA, Lluch A

The clinical decision to treat early-stage breast cancer with adjuvant chemotherapy is sometimes a difficult one because 70-80% of patients who receive chemotherapy would probably have survived without it. To help clinicians in this decision-making process, different tools or ‘decision aids’ have been developed for the treatment of early breast cancer over the years. Some of these tools include clinical treatment guidelines and computer-based programs as well as different prognostic and/or predictive tests such as those based on gene expression profiles or the presence minimum invasive disease. All of these tools try to individualize as much as possible the estimation of the risk of breast cancer relapse and death and to facilitate the clinical decision about giving additional treatment, and ultimately the most appropriate treatment to be given. Thus, it is important for clinicians to be aware of not only the existence of these tools or ‘decision aids’, but also to know how they have been developed, how frequently there are revised and if they have been validated. In order to address all these concerns, we have carried out a critical review of the most important prognostic tests and clinical guidelines for the treatment of early breast cancer. Information regarding their development process as well as frequency of revision, validations that have been performed and main limitations of each tool were gathered and critically analyzed.

PMID: 18922644 [PubMed - as supplied by publisher]

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Using consensus methods to develop clinical practice guidelines for intensive care: The Intensive Care Collaborative project.

Aust Crit Care. 2008 Oct 13;

Authors: Rolls KD, Elliott D

BACKGROUND: Clinical practices or procedures based on the best available evidence are an essential resource within an intensive care unit (ICU). Maintaining the currency of a local clinical practice manual is challenging however, particularly in relation to the time required, other workload pressures and the availability of staff with relevant skills to interrogate the literature. The aim of the Intensive Care Collaborative (ICC) project was to use the synergism of group processes to develop state-based clinical guidelines for six common intensive care practices - eye care, oral care, endotracheal tube management, suctioning, arterial line management, and central venous catheter (CVC) management. METHODS: Participants were 55 senior nurse clinicians from all nine area health services in NSW, seven academic facilitators, and staff from the Intensive Care Coordination and Monitoring Unit (ICCMU). A range of approaches were used to develop the six clinical practice guidelines (CPG) and related systematic literature reviews, including a preparatory educational seminar for participants, formation of working groups of clinicians, with subsequent teleconferences, e-mail and online forums to identify the scope of each guideline and review the literature. A consensus development conference (CDC) was conducted to finalise the reviews with a nominal group technique (NGT) used to develop recommendations for practice. External Validation Panels (EVP) verified the recommendations in each clinical practice guideline. Group voting was undertaken using a Likert scale (1-3 disagree, 4-6 neutral, 7-9 agree) with consensus agreement set as a median of at least seven. RESULTS: Eighty-three recommendations for practice were developed for the six Clinical Practice Guidelines; 50% were based on research literature evidence (23% with high levels of evidence). The balance were based on consensus opinion of the panel members. Only five recommendations were not validated by external validation. CONCLUSION: This project has demonstrated a method for guideline development that is robust, incorporating evidence from research and clinical expertise utilising an objective egalitarian framework.

PMID: 18922699 [PubMed - as supplied by publisher]

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[Liberalisation of Preoperative Fasting Guidelines: Effects on Patient Comfort and Clinical Practicability during Elective Laparoscopic Surgery of the Lower Abdomen.]

Zentralbl Chir. 2008 Oct;133(5):479-85

Authors: Meisner M, Ernhofer U, Schmidt J

INTRODUCTION: In this study, the recently liberalised national guidelines for preoperative fasting were evaluated from the view point of the patients and according to their clinical usability. PATIENTS AND METHODS: Patients undergoing elective laparoscopic gynaecological surgery were randomised into two groups. Patients in the long-time NPO-group (LTNPO-group) had nothing per mouth after midnight whereas patients in the short-time NPO-group (STNPO-group) did not receive any oral nutrition after midnight but were allowed an unlimited intake of Pfrimmer Nutricia preOP(R) up to 2 hours before scheduled surgery. Patients were asked to assess the incidence of 12 symptoms of perioperative discomfort prior to and 4-6 hours after surgery using a standardised questionnaire. Gastric fluid volume, vital signs during the induction period of anaesthesia and the actual duration of fasting were registered and compared. RESULTS: 42 patients were included into the study (LTNPO-group: n = 23, STNPO-group: n = 19). The actual duration of fasting for solid nutritition was 11.3 h in the LTNPO-group and 10.9 h in the STNPO-group, respectively. The time of fasting for fluids was in the STNPO-group significantly shorter (4.5 h) compared to the LTNPO-group (11.3 h). The patients of the STNPO-group reported preoperatively a significant lower incidence of “feeling cold” and pre- and postoperatively of “thirst / having a dry mouth”. No significant differences were reported between the groups with respect to heart rate, blood pressure, gastric volume, need of vasopressors and infusion requirements. DISCUSSION: The liberation of the national guidelines for preoperative fluid administration with unlimited intake of a carbohydrate drink offers the benefit of a significantly lower incidence of the preoperative item “feeling cold” and of the pre- and postoperative item “thirst / having a dry mouth”. However, in daily clinical practice the length of fasting for fluids was conspicuously longer than that postulated by the new recommendations.

PMID: 18924048 [PubMed - in process]

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Peer Review of Guidelines, Best Practice Statements and New Documents: What This Means for How We Use Them.

J Urol. 2008 Oct 16;

Authors: Droller MJ

PMID: 18930290 [PubMed - as supplied by publisher]

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Use of a Fall Prevention Practice Guideline for Community-Dwelling Older Persons at Risk for Falling: A Feasibility Study.

Gerontology. 2008 Oct 16;

Authors: Milisen K, Geeraerts A, Dejaeger E

Background: Falls among older persons occur frequently and are a common cause of physical and psychological morbidity and healthcare utilization. The problem can be attributed to a complex interaction between health-related, behavioral and environmental factors. To ensure a uniform and evidence-based approach, a practice guideline was developed for fall prevention in community-dwelling older persons at risk for falls. Objective: To test the feasibility of integrating a fall prevention practice guideline into the daily practice of 4 primary healthcare disciplines, i.e. general practitioners, nurses, occupational therapists and physiotherapists. Methods: This was a descriptive study which was carried out by 10 local health networks located throughout Flanders. The subjects involved in the study were 99 primary care workers and 1,142 community-dwelling older patients (65 years or older) who could rise from a chair and transfer independently. For 6 months, primary care workers implemented our fall prevention guideline, which consisted of 3 parts (case finding, multifactorial in-depth assessment and interventions). After the 6-month trial phase, participating primary care workers were asked to complete a semistructured questionnaire to evaluate the feasibility of using the guideline in daily practice. Results: The average time spent on carrying out the guideline was 32.0 +/- 14.0 min. Healthcare workers from all 4 disciplines considered case finding to be their responsibility. The picture was different for the evaluation of risk factors and interventions. Although 87.5% considered fall prevention to be an important issue, healthcare workers from different disciplines failed to agree about how to integrate the prevention guideline into daily practice. Perceived barriers to implementing the guideline were lack of time (57.3%), poor motivation of the target population (53.3%) and insufficient cooperation between healthcare workers (37.3%). Conclusion: A guideline can be used to initiate the integration of prevention strategies into daily practice. Case finding is feasible for all disciplines. Multifactorial assessment and interventions require specific task allocation, multidisciplinary cooperation and clear communication.

PMID: 18931476 [PubMed - as supplied by publisher]

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Pan-Canadian Evaluation of Irreversible Compression Ratios ("Lossy" Compression) for Development of National Guidelines.

J Digit Imaging. 2008 Oct 18;

Authors: Koff D, Bak P, Brownrigg P, Hosseinzadeh D, Khademi A, Kiss A, Lepanto L, Michalak T, Shulman H, Volkening A

New technological advancements including multislice CT scanners and functional MRI, have dramatically increased the size and number of digital images generated by medical imaging departments. Despite the fact that the cost of storage is dropping, the savings are largely surpassed by the increasing volume of data being generated. While local area network bandwidth within a hospital is adequate for timely access to imaging data, efficiently moving the data between institutions requires wide area network bandwidth, which has a limited availability at a national level. A solution to address those issues is the use of lossy compression as long as there is no loss of relevant information. The goal of this study was to determine levels at which lossy compression can be confidently used in diagnostic imaging applications. In order to provide a fair assessment of existing compression tools, we tested and compared the two most commonly adopted DISCOM compression algorithms: JPEG and JPEG-2000. We conducted an extensive pan-Canadian evaluation of lossy compression applied to seven anatomical areas and five modalities using two recognized techniques: objective methods or diagnostic accuracy and subjective assessment based on Just Noticeable Difference. By incorporating both diagnostic accuracy and subjective evaluation techniques, enabled us to define a range of compression for each modality and body part tested. The results of our study suggest that at low levels of compression, there was no significant difference between the performance of lossy JPEG and lossy JPEG 2000, and that they are both appropriate to use for reporting on medical images. At higher levels, lossy JPEG proved to be more effective than JPEG 2000 in some cases, mainly neuro CT. More evaluation is required to assess the effect of compression on thin slice CT. We provide a table of recommended compression ratios for each modality and anatomical area investigated, to be integrated in the Canadian Association of Radiologists standard for the use of lossy compression in medical imaging.

PMID: 18931879 [PubMed - as supplied by publisher]

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