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Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) hepatitis C guidelines: a European Renal Best Practice (ERBP) position statement.

Nephrol Dial Transplant. 2009 Mar;24(3):719-27

Authors: Covic A, Abramowicz D, Bruchfeld A, Leroux-Roels G, Samuel D, van Biesen W, Zoccali C, Zoulim F, Vanholder R,

PMID: 19202192 [PubMed - in process]

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Guidelines for acromegaly management: an update.

J Clin Endocrinol Metab. 2009 Feb 10;

Authors: Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A

Objective: The Acromegaly Consensus Group reconvened in November 2007, to update guidelines for acromegaly management. Participants: The meeting participants comprised 68 pituitary specialists including neurosurgeons and endocrinologists with extensive experience treating patients with acromegaly. Evidence/consensus process: Goals of treatment and the appropriate imaging, and biochemical and clinical monitoring of patients with acromegaly, were enunciated, based on the available published evidence. Conclusions :The group developed a consensus on the approach to managing acromegaly including appropriate roles for neurosurgery, medical therapy and radiation therapy in the management of these patients.

PMID: 19208732 [PubMed - as supplied by publisher]

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Implementation of standardized nutrition guidelines by renal dietitians is associated with improved nutrition status.

J Ren Nutr. 2009 Mar;19(2):136-44

Authors: Campbell KL, Ash S, Zabel R, McFarlane C, Juffs P, Bauer JD

OBJECTIVE: Standardized nutrition guidelines that focus on a nutrition care process have been used by dietitians treating renal patients in Australia for over 3 years. We show the impact of this implementation on the nutritional status of a cohort of hemodialysis patients. DESIGN: We conducted a retrospective observational study, investigating a cohort of maintenance hemodialysis patients after the implementation of a systematic approach to the patient's nutritional care. SETTING: This study took place in public and private in-center hemodialysis units. PATIENTS: Patients included a cohort of 65 maintenance hemodialysis patients (mean age +/- SD, 64 +/- 15 years; 58% male; dialysis vintage median [interquartile range], 22 [10 to 46] months). INTERVENTIONS: All participants were provided with a dietary interview at least every 6 months, with intensive follow-up where required, and were monitored monthly regarding weight and biochemistry. Outcomes were assessed annually between May 2004 and December 2006, after the implementation of this model of care. MAIN OUTCOME MEASURE: Energy and protein intake according to dietary interview, nutritional status according to subjective global assessment, and data regarding dry weight and biochemistry (including albumin, potassium, and phosphate) were collected by the dietitian at each facility. Change in each outcome measure over time was assessed using repeated-measures analysis. RESULTS: The proportion of patients with malnutrition (subjective global assessment B or C) decreased from 14% at baseline to 3% after 2 years. Serum albumin, potassium, and dry weight remained stable throughout the study period, and there was a significant decrease in serum phosphate over time (mean +/- SD,1.8 +/- 0.5 to 1.5 +/- 0.5 mmol/L, P = .004). Dietary energy and protein intake changed significantly over the study period (P = .001 and P = .022, respectively), with the highest mean intake recorded during the final follow-up assessment. CONCLUSIONS: The implementation of a systematic approach to patient care, in line with nutrition management guideline recommendations, was associated with an improvement in nutritional status and dietary intake in this cohort of maintenance hemodialysis patients, without the need for increased resources or dietitian time.

PMID: 19218040 [PubMed - in process]

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Antihypertensive Prescriptions for Newly Treated Patients Before and After the Main Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Results and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Guidelines.

Hypertension. 2009 Feb 16;

Authors: Muntner P, Krousel-Wood M, Hyre AD, Stanley E, Cushman WC, Cutler JA, Piller LB, Goforth GA, Whelton PK

Main results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial were published in December 2002. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, published in May 2003, recommended thiazide-type diuretics as initial pharmacological treatment alone or in combination with another drug in most patients with hypertension. To assess changes from before to after these publications, we compared antihypertensive medication prescriptions filled by patients who initiated pharmacological antihypertensive treatment in a large managed care organization during 3 time periods: (1) July 1, 2001, to June 30, 2002 (before these publications; n=1354); (2) July 1, 2003, to June 30, 2004 (to assess short-term changes; n=1542); and (3) July 1, 2004, to June 30, 2005 (to assess extended changes; n=1865). The percentage of patients initiating antihypertensive treatment with a thiazide-type diuretic increased from 30.6% to 39.4% (P<0.001) between 2001-2002 and 2003-2004, and the increase was maintained at 36.5% in 2004-2005 (P<0.001 compared with 2001-2002 and P=0.33 compared with 2003-2004). Among patients without diabetes mellitus, renal disease, a history of myocardial infarction, or heart failure, the percentage initiating pharmacological antihypertensive treatment with a thiazide-type diuretic increased from 33.1% in 2001-2002 to 43.4% in 2003-2004 (P<0.001) and remained increased (41.0%) in 2004-2005 (P<0.001 and P=0.23 compared with 2001-2002 and 2003-2004, respectively). Despite a sustained increase in the use of thiazide-type diuretics, this study indicates that an opportunity exists to increase adherence to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines.

PMID: 19221214 [PubMed - as supplied by publisher]

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Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs.

Intensive Care Med. 2009 Feb 17;

Authors: Prat G, Lefèvre M, Nowak E, Tonnelier JM, Renault A, L'her E, Boles JM

OBJECTIVE: To assess the impact of clinical guidelines to improve appropriate use of routine laboratory tests and bedside chest radiographs in a medical intensive care. DESIGN: A two-year (Period-1: 2005, Period-2: 2006), retrospective, comparative study, before and after policy implementation. PATIENTS: All consecutive patients admitted during the study periods. SETTING: A university hospital 15-bed medical ICU. INTERVENTION: Multifaceted intervention combining a daily routine prescription help-guide developed by a multidisciplinary group and displayed at patient's bedside, educational sessions and feedbacks by information on volumes of prescription. Individual adaptation to patient's clinical status was allowed by protocol. ASSESSMENT: The overall number and cost of laboratory tests and chest radiographs during Period-2 (with the help guide; from 01 to 12-2006) were compared to Period-1 (from 01 to 12-2005). RESULTS: Patients' general characteristics were similar during the two periods. A relative reduction of routine laboratory tests performance was observed per patient-ICU-day, ranging from 38 to 71.5% depending on the type of tests (P < 0.001 in all cases). For chest radiographs, a 41% relative reduction was observed between the two periods (P < 0.001). Daily ICU laboratory tests and chest radiographs cost per patient decreased from 114 to 56. An overall 300,000 ICU cost reduction was directly related to the protocol implementation. CONCLUSION: The implementation of a laboratory tests and chest radiographs prescription protocol within our ICU induced an important cost saving.

PMID: 19221715 [PubMed - as supplied by publisher]

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Effects of Dietary Factors on Drug Transport and Metabolism: The Impact on Dosage Guidelines in Transplant Patients.

Clin Pharmacol Ther. 2009 Feb 18;

Authors: Nowack R, Andrassy J, Fischereder M, Unger M

PMID: 19225452 [PubMed - as supplied by publisher]

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An evidence-based practice guideline for the peer review of electronic search strategies.

J Clin Epidemiol. 2009 Feb 18;

Authors: Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C

OBJECTIVE: Complex and highly sensitive electronic literature search strategies are required for systematic reviews; however, no guidelines exist for their peer review. Poor searches may fail to identify existing evidence because of inadequate recall (sensitivity) or increase the resource requirements of reviews as a result of inadequate precision. Our objective was to create an annotated checklist for electronic search strategy peer review. STUDY DESIGN: A systematic review of the library and information retrieval literature for important elements in electronic search strategies was conducted, along with a survey of individuals experienced in systematic review searching. RESULTS: Six elements with a strong consensus as to their importance in peer review were accurate translation of the research question into search concepts, correct choice of Boolean operators and of line numbers, adequate translation of the search strategy for each database, inclusion of relevant subject headings, and absence of spelling errors. Seven additional elements had partial support and are included in this guideline. CONCLUSION: This evidence-based guideline facilitates the improvement of search quality through peer review, and thus the improvement in quality of systematic reviews. It is relevant for librarians/information specialists, journal editors, developers of knowledge translation tools, research organizations, and funding bodies.

PMID: 19230612 [PubMed - as supplied by publisher]

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[Clinical guideline for the evaluation of liver transplant candidates with addictions.]

Gastroenterol Hepatol. 2009 Mar;32(3):155-61

Authors: Lligoña A, Freixa N, Bataller R, Monràs M, Rimola A

Liver transplantation is the only effective treatment for advanced cirrhosis. Nevertheless, the number of potential recipients far exceeds that of available donors. Therefore, liver transplant candidates must be carefully selected to optimize donor utilization. Candidate selection is complex in patients with addictive and/or psychopathological disorders. Alcohol consumption causes one-third of advanced liver disease in our environment and comorbid consumption of other addictive substances is frequent in these patients. The use or abuse of these substances in transplant recipients can be associated with graft loss. Despite the importance of this subject, there is no well established protocol in our environment for the evaluation and selection of candidates with addictive and/or psychopathological disorders. Therefore, a specific diagnostic and therapeutic strategy must be established for these patients. Hospital Clínic in Barcelona has an active liver transplantation program (90 transplantations in 2007). Since the start of this program in 1988, candidates with addictive and/or psychopathological disorders have been evaluated jointly by the Hepatology Service and Alcohol Unit, including psychiatrists, psychologists and social workers. We present the protocol approved by the Committee for Liver Transplantation and the Ethics Committee of Hospital Clínic in 2007 for the evaluation, selection and follow-up of transplant candidates with addictive and/or psychopathological disorders. This protocol includes a description of the evaluation process and defines the inclusion and exclusion criteria with respect to consumption of toxic substances, the social and family situation and psychiatric disorders. In addition, recommendations for the follow-up of these patients are provided.

PMID: 19232780 [PubMed - in process]

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Prompt and powerful effect of a practice guideline on caudal additives.

Paediatr Anaesth. 2009 Mar;19(3):271-2

Authors: Eich C, Strauss J

PMID: 19236648 [PubMed - in process]

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Value for Money in Changing Clinical Practice: Should Decisions about Guidelines and Implementation Strategies Be Made Sequentially or Simultaneously?

Med Decis Making. 2009 Feb 23;

Authors: Hoomans T, Severens JL, Evers SM, Ament AJ

Decisions about clinical practice change, that is, which guidelines to adopt and how to implement them, can be made sequentially or simultaneously. Decision makers adopting a sequential approach first compare the costs and effects of alternative guidelines to select the best set of guideline recommendations for patient management and subsequently examine the implementation costs and effects to choose the best strategy to implement the selected guideline. In an integral approach, decision makers simultaneously decide about the guideline and the implementation strategy on the basis of the overall value for money in changing clinical practice. This article demonstrates that the decision to use a sequential v. an integral approach affects the need for detailed information and the complexity of the decision analytic process. More importantly, it may lead to different choices of guidelines and implementation strategies for clinical practice change. The differences in decision making and decision analysis between the alternative approaches are comprehensively illustrated using 2 hypothetical examples. We argue that, in most cases, an integral approach to deciding about change in clinical practice is preferred, as this provides more efficient use of scarce health-care resources.

PMID: 19237645 [PubMed - as supplied by publisher]

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