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A pilot survey of the use and implementation of cardiac markers in acute coronary syndrome and heart failure across Europe The CARdiac MArker Guideline Uptake in Europe (CARMAGUE) study.

Clin Chem Lab Med. 2008 Dec 22;

Authors: Pulkki K, Suvisaari J, Collinson P, Ravkilde J, Stavljenic-Rukavina A, Hammerer-Lercher A, Baum H, van Dieijen-Visser MP, Laitinen P

Abstract Background: Guidelines on preferred cardiac marker strategies for investigation of patients with acute coronary syndromes (ACS) are available from the laboratory medicine and cardiology communities. Therefore, implementation of these guidelines into daily clinical practice should be a joint effort of laboratory specialists and clinicians. This was investigated in this survey. Methods: A pilot study was performed sponsored by the European Federation of Clinical Chemistry and Laboratory Medicine. A link to an online questionnaire was e-mailed to 990 laboratories from eight European countries in May 2006. The requested information included tests performed, clinical protocol development, and reference limits. Results: We obtained a total of 220 responses. Out of these, 208 responses (95%) were from hospitals that provide 24-h admission of patients. The suggested turn-around-time (<60 min) was apparently met by >88% for cardiac troponin T/I and for CK-MB mass. The majority of the laboratories derive their decision limits from kit inserts provided by the manufacturers. The results revealed a worrying fact that external quality assessments are not used in all testing. Conclusions: Our survey demonstrated that cardiac troponin is the preferred biomarker for the diagnosis of ACS. Half of the participants had written protocols, mostly as a result of collaboration between laboratorians and clinicians. Clin Chem Lab Med 2009;47.

PMID: 19099527 [PubMed - as supplied by publisher]

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Awareness and implementation of tobacco dependence treatment guidelines in Arizona: Healthcare Systems Survey 2000.

Health Res Policy Syst. 2008 Dec 19;6(1):13

Authors: Gilles ME, Strayer LJ, Leischow R, Feng C, Menke JM, Sechrest L

ABSTRACT: BACKGROUND: This paper presents findings from the Tobacco Control in Arizona Healthcare Systems Survey, conducted in 2000. The purpose of the survey was to assess the status of Arizona healthcare systems' awareness and implementation of tobacco cessation and prevention measures. METHODS: The 20-item survey was developed by The University of Arizona HealthCare Partnership in collaboration with the Arizona Department of Health Services Bureau of Tobacco Education and Prevention. It was mailed to representatives of Arizona's 40 healthcare systems, including commercial and Medicare managed care organizations, "managed Medicaid" organizations, Veterans Affairs Health Care Systems, and Indian Health Service Medical Centers. Thirty-three healthcare systems (83%) completed the survey. RESULTS: The majority of healthcare systems reported awareness of at least one tobacco cessation and prevention clinical practice guideline, but only one third reported full guideline implementation. While a majority covered some form of behavioral therapy, less than half reported covering tobacco treatment medications. "Managed Medicaid" organizations administered through the Arizona Health Care Cost Containment System were significantly less likely to offer coverage for behavioral therapy and less likely to cover pharmacotherapy than were their non-Medicaid counterparts in managed care, Veterans Affairs Health Care Systems and Indian Health Service Medical Centers. CONCLUSIONS: Arizona healthcare system coverage for tobacco cessation in the year 2000 was comparable to national survey findings of the same year. The findings that only 10% of "Managed Medicaid" organizations covered tobacco treatment medication and were significantly less likely to cover behavioral therapy were important given the nearly double smoking prevalence among Medicaid patients. Throughout the years of the program, the strategic plan of the Arizona Department of Health Services Bureau of Tobacco Education and Prevention has included the goal of identifying and eliminating tobacco related disparities for special populations, including low-income groups. Of importance, in 2008 the Arizona Health Care Cost Containment System was authorized to provide tobacco cessation pharmacotherapy as a covered benefit for its members.

PMID: 19099593 [PubMed - as supplied by publisher]

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Reconsidering Patient Participation in Guideline Development.

Health Care Anal. 2008 Dec 20;

Authors: van de Bovenkamp HM, Trappenburg MJ

Health care has become increasingly patient-centred and medical guidelines are considered to be one of the instruments that contribute towards making it so. We reviewed the literature to identify studies on this subject. Both normative and empirical studies were analysed. Many studies recommend active patient participation in the process of guideline development as the instrument to make guidelines more patient-centred. This is done on the assumption that active patient participation will enhance the quality of the guidelines. We found no empirical evidence, however, to support this assumption. Moreover, the studies show that patients experience several difficulties in the participation process, which cannot solely be traced back to flawed practices. Given this poor track record we conclude that the plea to actively involve patients in the guideline development process should be reconsidered.

PMID: 19101804 [PubMed - as supplied by publisher]

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Improving adherence to guidelines for acute stroke management.

Circulation. 2009 Jan 6;119(1):16-8

Authors: Dippel DW, Simoons ML

PMID: 19103985 [PubMed - in process]

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Hyperbilirubinemia guideline adherence in Russia illustrates universal challenges.

Eur J Pediatr. 2008 Dec 23;

Authors: Agulnik A, Ryumina II, Burgos AE

Guidelines for management of newborn hyperbilirubinemia have existed in Russia for many years. We sought to determine the degree to which management of hyperbilirubinemia in Russia meets three existing clinical protocols. We performed a cross-sectional chart review in a government-run, academic hospital in an urban setting in Moscow, Russia. Subjects were admitted to Level II nursery at Hospital No.13, were not transferred to a Level III nursery, did not die during hospitalization, and had at least one pairing of total serum bilirubin (TSB) and clinical evaluation of jaundice. We measured physician adherence to three available guidelines based upon TSB levels at which phototherapy and exchange transfusions were performed. We identified 594 infants and 1,924 pairings. Despite availability of TSB to inform decision-making, physicians did not follow the protocols. Under Russian and U.S. guidelines, physicians often failed to start phototherapy, started phototherapy unnecessarily, and missed recommended exchange transfusions. Despite a resource-poor setting, guideline adherence in Russia was remarkably similar to that of U.S. physicians. The data illustrate the challenge of overcoming physician behavior to standardize practice, and raise questions about the presumed higher quality of care in a more developed medical system. A new framework for guideline implementation is needed, and many of the necessary tools already exist.

PMID: 19104835 [PubMed - as supplied by publisher]

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AIUM practice guideline for the performance of an ultrasound examination for detection and assessment of developmental dysplasia of the hip.

J Ultrasound Med. 2009 Jan;28(1):114-9

Authors: ,

PMID: 19106370 [PubMed - in process]

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Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project.

J Gen Intern Med. 2009 Jan;24(1):147

Authors: Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S,

PMID: 19107541 [PubMed - as supplied by publisher]

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Acute myocardial infarction in nursing home residents: adherence to treatment guidelines reduces mortality, but why is adherence so low?

J Am Med Dir Assoc. 2009 Jan;10(1):56-61

Authors: Levy CR, Radcliff TA, Williams ET, Hutt E

OBJECTIVES: To investigate the applicability of clinical practice guidelines (CPGs) to the care of nursing home (NH) residents who experience acute myocardial infarction (AMI). DESIGN: Secondary examination of data from the national Cooperative Cardiovascular Project. SETTING: 6684 US hospitals. PARTICIPANTS: A NH-dwelling (N = 8151) cohort and a community-dwelling cohort (N = 119,012). MEASUREMENTS: Adherence to AMI guidelines and associated mortality rates. RESULTS: Mortality at 30 days and 1 year respectively was 39.5% and 65.4% in the NH cohort versus 17.5% and 31.1% in the community-dwelling cohort (P < .001). Among patients who were ideally eligible to receive aspirin, 58.8% of the NH cohort and 78.9% of the community-dwelling cohort actually received aspirin (P < .001). Among patients who were ideally eligible for beta-blockers, 43.8% of the NH cohort and 61.4% of the community-dwelling cohort received beta-blockers (P < .001). The 30-day mortality for NH patients who were ideally eligible for aspirin but did not receive aspirin was significantly higher compared with NH patients who were ideally eligible but did receive aspirin (49.2% versus 26.0%, P < .001). Similarly, mortality was significantly higher for NH patients who were ideally eligible for beta-blockers but did not receive a beta-blocker (35.3% versus 18.6%, P < .001). CONCLUSION: Only half of NH patients who are ideally eligible for aspirin and beta-blockers received these medications, yet mortality was significantly lower in patients who were treated with these medications. These results demonstrate the effect of applying AMI guidelines to NH patients while also raising the question of what factors guided decisions not to provide these medications.

PMID: 19111854 [PubMed - in process]

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Mucopolysaccharidosis I: management and treatment guidelines.

Pediatrics. 2009 Jan;123(1):19-29

Authors: Muenzer J, Wraith JE, Clarke LA,

OBJECTIVE: Disease management for mucopolysaccharidosis type I has been inconsistent because of disease rarity (approximately 1 case per 100,000 live births), phenotypic heterogeneity, and limited therapeutic options. The availability of hematopoietic stem cell transplantation and the recent introduction of enzyme replacement therapy for mucopolysaccharidosis I necessitate the establishment of system-specific management guidelines for this condition. METHODS: Twelve international experts on mucopolysaccharidosis I met in January 2003 to draft management and treatment guidelines for mucopolysaccharidosis I. Initial guidelines were revised and updated in 2008, on the basis of additional clinical data and therapeutic advances. Recommendations are based on our extensive clinical experience and a review of the literature. RESULTS: All patients with mucopolysaccharidosis I should receive a comprehensive baseline evaluation, including neurologic, ophthalmologic, auditory, cardiac, respiratory, gastrointestinal, and musculoskeletal assessments, and should be monitored every 6 to 12 months with individualized specialty assessments, to monitor disease progression and effects of intervention. Patients are best treated by a multidisciplinary team. Treatments consist of palliative/supportive care, hematopoietic stem cell transplantation, and enzyme replacement therapy. The patient's age (>2 years or < or =2 years), predicted phenotype, and developmental quotient help define the risk/benefit profile for hematopoietic stem cell transplantation (higher risk but can preserve central nervous system function) versus enzyme replacement therapy (low risk but cannot cross the blood-brain barrier). CONCLUSION: We anticipate that provision of a standard of care for the treatment of patients with mucopolysaccharidosis I will optimize clinical outcomes and patients' quality of life.

PMID: 19117856 [PubMed - in process]

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Measuring adherence to hand hygiene guidelines: A field survey for examples of effective practices.

Am J Infect Control. 2008 Dec 30;

Authors: Braun BI, Kusek L, Larson E

BACKGROUND: Measuring adherence to hand hygiene guidelines is resource intensive and complicated by lack of standardized methodology. The multiplicity of approaches in use makes it difficult to meaningfully compare performance across health care organizations. The goal of this project was to identify promising and effective practices for measuring adherence with hand hygiene guidelines across a variety of settings. METHODS: A cross-sectional survey was conducted electronically in February 2007 to collect information on aspects of hand hygiene measured (eg, frequency, thoroughness of technique, glove use, product consumption), data collection approaches, training and resources, reports, and others. Invitations to respond were widely distributed through Web site announcements and list-serve messages of The Joint Commission and collaborating organizations. A panel of national experts developed and applied criteria for evaluating the methods. RESULTS: Two hundred forty-two responses were submitted from a variety of settings and countries. Most (approximately 75%) measured frequency of hand hygiene; approximately 50% measured thoroughness, glove use, product usage, patient and provider satisfaction, or other aspects. Seventy-two percent relied exclusively on manual data collection, and most methods (80%) had been in use for less than 3 years. Most (65%) spent less than 1 hour in training data collectors, and few had evidence of reliability or validity. Forty submissions met most criteria for inclusion in an educational monograph. CONCLUSION: Among respondents who considered their approach to be an example of an effective practice, there was substantial variation in methods and little evidence of reliability. Standardization of methods is needed to compare performance across organizations or within an organization over time.

PMID: 19118921 [PubMed - as supplied by publisher]

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