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[Nobel price for vaccination against cervical cancer: Current data and guidelines.]

Internist (Berl). 2009 Apr 22;

Authors: Hepburn HM, Kaufmann AM

Harald zur Hausen received the Nobel price for Medicine in 2008 for his seminal research on human papilloma viruses and their association with anogenital diseases. On the basis of his work highly effective prophylactic vaccines have been developed. Clinical studies have shown nearly 100% seroconversion and an excellent safety profile as well as greater than 96% efficacy against HPV infection and premalignant dysplasia, induced by HPV types covered by the vaccine. Due to the convincing data of phase II and III clinical trials the introduction of HPV vaccination was recommended by health authorities and scientific committees in Germany. The development and availability of guidelines and evidence-based recommendations should support the introduction of the vaccine and widespread vaccination.

PMID: 19384543 [PubMed - as supplied by publisher]

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Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial.

Donnerstag, 07. Mai 2009

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Interactive spaced education to assess and improve knowledge of clinical practice guidelines: a randomized controlled trial.

Ann Surg. 2009 May;249(5):744-9

Authors: Kerfoot BP, Kearney MC, Connelly D, Ritchey ML

OBJECTIVE: To determine whether Interactive Spaced Education (ISE) is an effective and acceptable form of graduate and continuing medical education (GME/CME), using clinical practice guideline (CPG) education as an experimental system. SUMMARY BACKGROUND DATA: ISE is a novel form of online education, which combines the pedagogical merits of the spacing and testing effects. Its efficacy for GME and CME is not known. METHODS: One-hundred sixty urologists and 320 urology residents were randomized to 1 of 2 cohorts. We developed and validated 48 ISE items (questions and answers) on 5 urology CPGs (hematuria and priapism [HP]; staghorn calculi, infertility, and antibiotic use [SIA]). Physicians were sent 3 emails a week, each containing 2 questions. Content was repeated 3 times over 20 weeks. Cohort A physicians received the 3-cycle ISE course on HP, with 24 control items on SIA in cycle 3. Cohort B physicians received the 3-cycle ISE course on SIA, with 24 control items on HP in cycle 3. RESULTS: The ISE program was completed by 71% urologists and 83% residents. Cohort A scores on HP increased from mean 44.9% in cycle 1% to 75.7% in cycle 3, a 57% relative increase compared with controls (P < 0.001; Cohen effect size, 2.2). Similarly, cohort B scores on SIA increased from 45.2% in cycle 1% to 69.5% in cycle 3, a 56% relative increase compared with controls (P < 0.001; effect size, 2.2). Eighty-four percent of all participants requested to enroll in further ISE programs. CONCLUSIONS: ISE is an effective and well-accepted form of GME and CME and is a promising new methodology to improve CPG knowledge.

PMID: 19387336 [PubMed - in process]

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How Well Do Guidelines Incorporate Evidence on Patient Preferences?

Donnerstag, 07. Mai 2009

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How Well Do Guidelines Incorporate Evidence on Patient Preferences?

J Gen Intern Med. 2009 Apr 23;

Authors: Chong CA, Chen IJ, Naglie G, Krahn MD

BACKGROUND: Clinical practice guidelines (CPG) are meant to consider important values such as patient preferences. OBJECTIVE: To assess how well clinical practice guidelines (CPGs) integrate evidence on patient preferences compared with that on treatment effectiveness. DESIGN: A cross-sectional review of a listing in 2006 of CPGs judged to be the best in their fields by an external joint government and medical association body. STUDY SELECTION: Exclusion criterion was unavailability in electronic format. Sixty-five of 71 listed CPGs met selection criteria. MEASUREMENTS: Two instruments originally constructed to evaluate the overall quality of CPGs were adapted to specifically assess the quality of integrating information on patient preference vs. treatment effectiveness. Counts of words and references in each CPG associated with patient preferences vs. treatment effectiveness were performed. Two reviewers independently assessed each CPG. MAIN RESULTS: Based on our adapted instruments, CPGs scored significantly higher (p < 0.001) on the quality of integrating treatment effectiveness compared with patient preferences evidence (mean instrument one scores on a scale of 0.25 to 1.00: 0.65 vs. 0.43; mean instrument two scores on a scale of 0 to 1: 0.58 vs. 0.18). The average percentage of the total word count dedicated to treatment effectiveness was 24.2% compared with 4.6% for patient preferences. The average percentage of references citing treatment effectiveness evidence was 36.6% compared with 6.0% for patient preferences. CONCLUSION: High quality CPGs poorly integrate evidence on patient preferences. Barriers to incorporating preference evidence into CPGs should be addressed.

PMID: 19387746 [PubMed - as supplied by publisher]

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A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence.

Donnerstag, 07. Mai 2009

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A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence.

Clin Rehabil. 2009 Apr 23;

Authors: Langer D, Hendriks EJ, Burtin C, Probst V, van der Schans CP, Paterson WJ, Verhoef-de Wijk MC, Straver RV, Klaassen M, Troosters T, Decramer M, Ninane V, Delguste P, Muris J, Gosselink R

Purpose: Update of a clinical practice guideline for the physiotherapy management of patients with chronic obstructive pulmonary disease supporting the clinical decision-making process.Methods: A systematic computerized literature search was performed on different modalities for improving physical exercise capacity, reducing exertional dyspnoea, improving airway clearance and encouraging changes in physical activity behaviour. Methodological quality was scored with the PEDro Scale. Scientific conclusions were graded according to the criteria of the ‘Dutch Evidence Based Guideline Development Platform’. These, together with practical considerations, were used to formulate recommendations for clinical practice.Results: A total of 103 studies were included in the systematic review, consisting of five meta-analyses of randomized controlled trials, 84 randomized controlled trials and 14 uncontrolled studies. Twenty scientific conclusions supported six recommendations on physical exercise training. Nineteen scientific conclusions supported eight recommendations on interventions for reducing dyspnoea. Five scientific conclusions supported seven recommendations concerning treatment modalities to improve mucus clearance, and two scientific conclusions supported two recommendations on strategies for encouraging permanent changes in physical activity behaviour.Conclusions: Strong recommendations support the use of physical exercise training to improve health-related quality of life and functional exercise capacity. Future research should investigate whether additional interventions for reducing exertional dyspnoea have a place as adjuncts to physical exercise training in selected patients. In addition, treatment of impaired mucus clearance, especially during acute exacerbations, requires further research. With the advance of new technologies for objective measurements of physical activities in daily life more research is needed concerning interventions to initiate and maintain physical activity behaviour change during and after supervised physical exercise training programmes.

PMID: 19389745 [PubMed - as supplied by publisher]

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Sirolimus in kidney transplantation indications and practical guidelines: de novo sirolimus-based therapy without calcineurin inhibitors.

Donnerstag, 07. Mai 2009

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Sirolimus in kidney transplantation indications and practical guidelines: de novo sirolimus-based therapy without calcineurin inhibitors.

Transplantation. 2009 Apr 27;87(8 Suppl):S1-6

Authors: Flechner SM

A de novo calcineurin inhibitor avoidance regimen based on sirolimus has been successfully used worldwide; demonstrating improved renal function from 1 to 5 years. This includes use of an induction antibody followed by sirolimus, mycophenolate mofetil, and steroids. This combination has a somewhat different side effect profile and wider experience has revealed that the use of de novo sirolimus requires careful therapeutic drug level monitoring, especially the first 6 months posttransplant. Experience has also demonstrated that delaying the introduction of sirolimus in patients considered at high risk for early mammalian target of rapamycin associated complications will optimize these results. For such recipients, the initial use of a calcineurin inhibitor drug for 2 to 4 months is preferred, followed by conversion to sirolimus. The late withdrawal of steroids may be possible, but awaits further evaluation in randomized controlled trials.

PMID: 19384179 [PubMed - in process]

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Effect of a minimal pharmacy intervention on improvement of adherence to asthma guidelines.

Donnerstag, 07. Mai 2009

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Effect of a minimal pharmacy intervention on improvement of adherence to asthma guidelines.

Arch Dis Child. 2009 Apr 23;

Authors: de Vries TW, van den Berg PB, Duiverman EJ, de Jong-van den Berg LT

OBJECTIVE: To study the effectiveness of a minimal intervention strategy to improve the adherence to paediatric asthma guidelines. Design and SETTING: A group of pharmacists was encouraged to discuss essential elements of asthma care with the general practitioners they normally worked with. The adherence to guidelines was evaluated by studying prescriptions for children with asthma. We compared the treatments of children who were registered at pharmacies who participated in the study (intervention group) with a control group of children, registered at other, non-participating pharmacies (reference group) and with results of an earlier study. MAIN OUTCOME MEASURES: The numbers of children who had no short-acting betamimetics, no inhaled corticosteroids while on long-acting betamimetics, and who had more than one type of inhaler. RESULTS: The number of children who had no short-acting betamimetics was significantly lower in the intervention group (176/1447 vs. 534/3527; p < 0.01); fewer children had no ICS although on long-acting betamimetics (6/219 vs. 41/477; p = 0.03). The number of children who had more than one type of inhaler was equal in both groups (5.1%), but this was significantly lower than compared to the earlier study (119/2311 vs. 239/3217; p <0.01). CONCLUSIONS: The assistance of pharmacists in adherence to paediatric asthma guidelines is beneficial. Pharmacists should be involved actively in the care of children with asthma.

PMID: 19395402 [PubMed - as supplied by publisher]

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An update on best practice guidelines for specialized facilities and resources necessary for weight loss surgical programs.

Obesity (Silver Spring). 2009 May;17(5):911-7

Authors: Lautz DB, Jiser ME, Kelly JJ, Shikora SA, Partridge SK, Romanelli JR, Cella RJ, Ryan JP

The objective of this study is to update evidence-based best practice guidelines for specialized facilities and resources for weight loss surgery (WLS). We performed systematic search of English-language literature on WLS and facilities, equipment, and resources published between April 2004 and May 2007 in PubMed, MEDLINE, and the Cochrane Library. Keywords were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. Evidence-based best practice recommendations from the most recent literature on specialized facilities and resources for WLS were developed. We identified 1,647 papers in our literature search; the 46 most relevant were reviewed in detail. Regular updates of evidence-based recommendations for best practices in facilities and resources for WLS are required to address technology advances and growing recognition of the need for adequate equipment and specially built nursing units. Key factors in patient safety include availability of trained personnel and specialized equipment for the care of extremely obese WLS patients.Obesity (2009) 17 5, 911-917. doi:10.1038/oby.2008.581.

PMID: 19396071 [PubMed - in process]

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Electronic e-isotretinoin prescription chart: improving physicians’ adherence to isotretinoin prescription guidelines.

Donnerstag, 07. Mai 2009

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Electronic e-isotretinoin prescription chart: improving physicians’ adherence to isotretinoin prescription guidelines.

Australas J Dermatol. 2009 May;50(2):107-12

Authors: Tang MB, Tan ES, Tian EA, Loo SC, Chua SH

Oral isotretinoin is a highly effective treatment for refractory nodulocystic acne. However, it can be associated with serious adverse effects such as teratogenicity and hepatitis. Inadequate cumulative dosing may also result in reduced therapeutic efficacy and higher disease relapse. A preliminary audit had previously revealed a poor and inconsistent adherence to local isotretinoin prescribing guidelines by physicians. To achieve greater than 90% adherence to isotretinoin guidelines for all acne patients prescribed systemic isotretinoin at the National Skin Centre, Singapore, key areas and the reasons for non-adherence were identified. A specifically designed ‘one-stop’ electronic isotretinoin chart was launched within the electronic medical records (EMR) system to address important safety areas; namely, informed patient consent, pregnancy testing, baseline laboratory tests, and automatic calculation of cumulative and target doses of isotretinoin. Physician adherence to prescribing guidelines improved from a baseline of 50-60% to greater than 90% (range 95-100%) for 30 consecutive months post intervention. The e-isotretinoin chart has resulted in significant improvement in physicians’ adherence to isotretinoin prescription guidelines and highlights the utility of EMR technology in influencing safe prescribing behaviour among doctors.

PMID: 19397562 [PubMed - in process]

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Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation.

Donnerstag, 07. Mai 2009

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Effect of guideline based computerised decision support on decision making of multidisciplinary teams: cluster randomised trial in cardiac rehabilitation.

BMJ. 2009;338:b1440

Authors: Goud R, de Keizer NF, ter Riet G, Wyatt JC, Hasman A, Hellemans IM, Peek N

OBJECTIVE: To determine the extent to which computerised decision support can improve concordance of multidisciplinary teams with therapeutic decisions recommended by guidelines. DESIGN: Multicentre cluster randomised trial. PARTICIPANTS: Multidisciplinary cardiac rehabilitation teams in Dutch centres and their cardiac rehabilitation patients. INTERVENTIONS: Teams received an electronic patient record system with or without additional guideline based decision support. MAIN OUTCOME MEASURES: Concordance with guideline recommendations assessed for two standard rehabilitation treatments-exercise and education therapy-and for two new but evidence based rehabilitation treatments-relaxation and lifestyle change therapy; generalised estimating equations were used to account for intra-cluster correlation and were adjusted for patient’s age, sex, and indication for cardiac rehabilitation and for type and volume of centre. RESULTS: Data from 21 centres, including 2787 patients, were analysed. Computerised decision support increased concordance with guideline recommended therapeutic decisions for exercise therapy by 7.9% (control 84.7%; adjusted difference 3.5%, 95% confidence 0.1% to 5.2%), for education therapy by 25.7% (control 63.9%; adjusted difference 23.7%, 15.5% to 29.4%), and for relaxation therapy by 25.5% (control 34.1%; adjusted difference 41.6%, 25.2% to 51.3%). The concordance for lifestyle change therapy increased by 3.2% (control 54.1%; adjusted difference 7.1%, -2.9% to 18.3%). Computerised decision support reduced cases of both overtreatment and undertreatment. CONCLUSIONS: In a multidisciplinary team motivated to adopt a computerised decision support aid that assists in formulating guideline based care plans, computerised decision support can be effective in improving the team’s concordance with guidelines. Therefore, computerised decision support may also be considered to improve implementation of guidelines in such settings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN36656997.

PMID: 19398471 [PubMed - in process]

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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

Donnerstag, 07. Mai 2009

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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

JPEN J Parenter Enteral Nutr. 2009 May-June;33(3):277-316

Authors: McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G, ,

PMID: 19398613 [PubMed - as supplied by publisher]

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