< ![CDATA[

Universal bilirubin screening, guidelines, and evidence.

Pediatrics. 2009 Oct;124(4):1199-202

Authors: Newman TB

PMID: 19786453 [PubMed - in process]

]]>

Related Articles

< ![CDATA[

Impact of splenic injury guidelines on hospital stay and charges in patients with isolated splenic injury.

Surgery. 2009 Oct;146(4):787-91; discussion 791-3

Authors: Izu BS, Ryan M, Markert RJ, Ekeh AP, McCarthy MC

BACKGROUND: The purpose of this study was to assess the impact of care guidelines for patients with isolated blunt splenic trauma on length of stay (LOS) and patient charges. METHODS: We conducted a review of the hospital trauma registry and identified patients admitted with blunt splenic injury from 2000 to 2007. Splenic injury guidelines were initiated in November 2004. Patients with other major injuries were excluded. Patients were grouped according to their American Association for the Surgery of Trauma (AAST) splenic injury grade, I-V. Hospital LOS, intensive care unit (ICU) LOS, and patient charges before and after the guidelines were compared. RESULTS: We identified 137 patients with isolated splenic injuries. Sixty-three patients were admitted before and 70 patients after implementation of the guidelines. ICU and hospital LOS were significantly decreased after the guidelines (ICU LOS, 1.35 days before, 0.80 after [P < .01]; and hospital LOS, 4.17 before, 3.27 after [P < .01]). When grouped by AAST grade, grade II injuries had a decrease in hospital LOS (4.5 before vs 2.29 after; P < .01) and ICU LOS (1.43 before vs 0.29 after; P < .01). Adjusted hospital charges showed no significant increase overall after the guideline implementation (mean hospital charges before $23,047 vs after, $24,116; P = .62). CONCLUSION: Implementing guidelines for the observation of blunt splenic injury decreased the overall hospital LOS and ICU LOS at our institution, but hospital charges remained the same. Trauma programs should institute splenic injury guidelines to reduce resources needed for the care of isolated splenic injuries.

PMID: 19789039 [PubMed - in process]

]]>

Related Articles

< ![CDATA[

Statins in acute coronary syndromes: do the guideline recommendations match the evidence?

J Am Coll Cardiol. 2009 Oct 6;54(15):1425-33

Authors: Morrissey RP, Diamond GA, Kaul S

On the basis of the evidence obtained from observational studies, randomized controlled trials and their meta-analyses, current guidelines recommend initiating high-dose statin therapy pre-discharge regardless of the baseline low-density lipoprotein (LDL) level in patients with acute coronary syndromes (ACS). Careful review of the evidence indicates that early initiation of high-dose statin therapy reduces recurrent ischemia and may reduce revascularization, but does not confer benefit in terms of hard clinical outcomes such as death or myocardial infarction in any of the randomized controlled trials, and may be associated with increased liver and muscle-related adverse outcomes leading to increased withdrawal and suboptimal long-term adherence. A mortality benefit is apparent in pooled analyses of randomized controlled trials only at long-term (24-month) but not short-term (4-month) follow-up. The critical role of the timing of initiation of therapy (early vs. late) on the benefit-risk profile of statin treatment has not been systematically assessed. It is unclear whether the clinical benefits are attributable to lipid-lowering or lipid-lowering-independent effects. Finally, an optimal LDL threshold for initiating treatment or target LDL level for treatment in ACS remains yet to be defined. On the basis of these observations, and despite a compelling pathophysiologic rationale, the justification for current Class I, Level of Evidence: A recommendation for statin therapy in patients with ACS remains open to question.

PMID: 19796735 [PubMed - in process]

]]>

Related Articles

< ![CDATA[

Early statin therapy in acute coronary syndromes: the successful cycle of evidence, guidelines, and implementation.

J Am Coll Cardiol. 2009 Oct 6;54(15):1434-7

Authors: Waters DD, Ku I

That statins should be prescribed for patients before hospital discharge after an episode of acute coronary syndrome (ACS) is a Level of Evidence: 1A recommendation of the American College of Cardiology/American Heart Association Joint Task Force. This level of recommendation is based upon 2 clinical trials: the MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering) and PROVE-IT (Pravastatin or Atorvastatin Evaluation and Infection Therapy) trials. In the MIRACL trial, 3,086 patients with unstable angina or non-Q-wave myocardial infarction were randomized within 4 days of the event to atorvastatin 80 mg/day or to placebo and followed for 16 weeks. The primary composite end point occurred in 14.8% of atorvastatin patients and 17.4% of placebo patients, a 16% relative risk reduction (p = 0.048). In the PROVE-IT trial, 4,162 patients hospitalized with an ACS within the preceding 10 days were randomized to atorvastatin 80 mg/day or pravastatin 40 mg/day and were followed for a mean of 24 months. The primary event rate was 22.4% in the atorvastatin group and 26.3% in the pravastatin group, a 16% relative risk reduction (p = 0.005). A strong trend toward a reduction in total mortality was seen in the atorvastatin group (2.2% vs. 3.2%, p = 0.07). Using a composite end point of death, myocardial infarction, and rehospitalization for ACS, the difference between the treatment groups is already statistically significant at 30 days and remains so throughout the follow-up period. Comprehensive treatment programs in ACS patients that include initiation of statins before hospital discharge have been shown to improve outcomes such as recurrent myocardial infarction and total mortality at 1 year. Guidelines prove their utility when their implementation improves outcomes across a broad population at risk, such as in this instance.

PMID: 19796736 [PubMed - in process]

]]>

Related Articles

< ![CDATA[

Evidence-based guidelines for prevention of perioperative hypothermia.

J Am Coll Surg. 2009 Oct;209(4):492-503.e1

Authors: Forbes SS, Eskicioglu C, Nathens AB, Fenech DS, Laflamme C, McLean RF, McLeod RS,

PMID: 19801323 [PubMed - in process]

]]>

Related Articles

< ![CDATA[

[Reporting guidelines are also useful for readers of medical research publications: CONSORT, STARD, STROBE and others]

Dtsch Med Wochenschr. 2009 Oct;134(41):2078-83

Authors: Meerpohl JJ, Blümle A, Antes G, Elm E

Over the last few years reporting guidelines for research papers have had increasing attention and use. They comprise recommendations and checklists, developed by expert groups consisting of researchers, methodologists and journal editors. They aim at ensuring the transparent description of research results. Following the CONSORT statement for the reporting of randomized controlled trials (RCTs), other reporting guidelines such as STARD for diagnostic accuracy studies, STROBE for observational studies and QUOROM for systematic reviews of RCTs have been published. This article discribes the concept of reporting guidelines for research reports and discusses searches of the international literature based on them. Selected reporting guidelines of particular interest are presented in detail. Nowadays, reporting guidelines exist for different areas of research and types of studies. The EQUATOR network (www.equator-network.org) offers a comprehensive overview. Other reporting guidelines are being prepared. It has been shown for some guidelines, in particular the CONSORT statement that they contribute to an improvement in reporting medical research. Existing guidelines should be assesed regularly for their timeliness and, if necessary, be updated. Reporting guidelines contribute to the improvement of the quality of medical research publications. They offer advice how to interpret and critically appraise the medical literature for authors but also for journal editors, reviewers and critical readers.

PMID: 19802771 [PubMed - in process]

]]>

Related Articles

< ![CDATA[

WHO releases Guidelines for trauma quality improvement programmes.

Inj Prev. 2009 Oct;15(5):359

Authors: Mock C

PMID: 19805610 [PubMed - in process]

]]>

Related Articles

< ![CDATA[

Impact of individual values on adherence to emergency contraception practice guidelines among pediatric residents: implications for training.

Arch Pediatr Adolesc Med. 2009 Oct;163(10):944-8

Authors: Upadhya KK, Trent ME, Ellen JM

OBJECTIVE: To evaluate the impact of individual, system, and interpersonal factors on emergency contraception practices. We hypothesized that abortion attitudes and attitudes toward teen sex would be significant individual factors influencing emergency contraception practices. DESIGN: This was a cross-sectional, anonymous Internet survey. SETTING: Four pediatric residency programs in the Baltimore, Maryland-Washington, DC, metropolitan area during April to June 2007. PARTICIPANTS: One hundred forty-one pediatric residents completed the survey. MAIN EXPOSURE: Abortion attitudes were assessed by participants' level of agreement with abortion in 7 scenarios. Attitudes toward teen sex were assessed by participants' level of agreement with 5 statements about the acceptability of teens having sex. MAIN OUTCOME MEASURES: Emergency contraceptive counseling behavior was assessed by reported frequency of including emergency contraception in routine contraceptive counseling. Intention to prescribe emergency contraception was assessed by reported likelihood of prescribing in 5 scenarios. RESULTS: When controlling for demographics and other predictors, residents with less favorable abortion attitudes were more likely to have the lowest intention to prescribe emergency contraception. Residents with more positive attitudes toward teen sex and who had a preceptor encourage emergency contraception prescription were more likely to include emergency contraception in routine contraceptive counseling most/all the time and to have the highest intention to prescribe. CONCLUSION: Efforts to challenge and affect attitudes toward teen sex and to prompt residents to prescribe emergency contraception in clinical settings may be needed to encourage more proactive emergency contraceptive practice in accordance with national practice guidelines.

PMID: 19805714 [PubMed - in process]

]]>

Related Articles

< ![CDATA[

Guidelines for practical use of MAL-PDT in non-melanoma skin cancer.

J Eur Acad Dermatol Venereol. 2009 Oct 6;

Authors: Christensen E, Warloe T, Kroon S, Funk J, Helsing P, Soler A, Stang H, Vatne O, Mørk C

Abstract Methyl aminolaevulinate photodynamic therapy is increasingly practiced in the treatment of actinic keratoses, Bowen's disease and basal cell carcinomas. This method is particularly suitable for treating multiple lesions, field cancerization and lesions in areas where a good cosmetic outcome is of importance. Good treatment routines will contribute to a favourable result. The Norwegian photodynamic therapy (PDT) group consists of medical specialists with long and extensive PDT experience. With support in the literature, this group presents guidelines for the practical use of topical PDT in non-melanoma skin cancer.

PMID: 19807828 [PubMed - as supplied by publisher]

]]>

< ![CDATA[

Unify the evaluative procedures and involve peers for increasing use of guidelines in daily practices.

Chest. 2009 Oct;136(4):1191

Authors: Vignally P, Gentile S, Souville M, Sambuc R

PMID: 19809082 [PubMed - in process]

]]>