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Evidence based guidelines for complex regional pain syndrome type 1.

BMC Neurol. 2010 Mar 31;10(1):20

Authors: Perez RS, Zollinger PE, Dijkstra PU, Thomassen-Hilgersom IL, Zuurmond WW, Rosenbrand KC, Geertzen JH, Task Force TC

ABSTRACT: BACKGROUND: Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. METHOD: A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment. RESULTS: For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I. CONCLUSIONS: Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.

PMID: 20356382 [PubMed - as supplied by publisher]

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Improved Out-of-Hospital Cardiac Arrest Survival After the Sequential Implementation of 2005 AHA Guidelines for Compressions, Ventilations, and Induced Hypothermia: The Wake County Experience.

Ann Emerg Med. 2010 Mar 30;

Authors: Hinchey PR, Myers JB, Lewis R, De Maio VJ, Reyer E, Licatese D, Zalkin J, Snyder G,

STUDY OBJECTIVE: We assess survival from out-of-hospital cardiac arrest after community-wide implementation of 2005 American Heart Association guidelines. METHODS: This was an observational multiphase before-after cohort in an urban/suburban community (population 840,000) with existing advanced life support. Included were all adults treated for cardiac arrest by emergency responders. Excluded were patients younger than 16 years and trauma patients. Intervention phases in months were baseline 16; phase 1, new cardiopulmonary resuscitation 12; phase 2, impedance threshold device 6; and phase 3, full implementation including out-of-hospital-induced hypothermia 12. Primary outcome was survival to discharge. Other survival and neurologic outcomes were compared between study phases, and adjusted odds ratios with 95% confidence intervals (CIs) for survival by phase were determined by multivariate regression. RESULTS: One thousand three hundred sixty-five cardiac arrest patients were eligible for inclusion: baseline n=425, phase 1 n=369, phase 2 n=161, phase 3 n=410. Across phases, patients had similar demographic, clinical, and emergency medical services characteristics. Overall and witnessed ventricular fibrillation and ventricular tachycardia survival improved throughout the study phases: respectively, baseline 4.2% and 13.8%, phase 1 7.3% and 23.9%, phase 2 8.1% and 34.6%, and phase 3 11.5% and 40.8%. The absolute increase for overall survival from baseline to full implementation was 7.3% (95% CI 3.7% to 10.9%); witnessed ventricular fibrillation/ventricular tachycardia survival was 27.0% (95% CI 13.6% to 40.4%), representing an additional 25 lives saved annually in this community. CONCLUSION: In the context of a community-wide focus on resuscitation, the sequential implementation of 2005 American Heart Association guidelines for compressions, ventilations, and induced hypothermia significantly improved survival after cardiac arrest. Further study is required to clarify the relative contribution of each intervention to improved survival outcomes.

PMID: 20359771 [PubMed - as supplied by publisher]

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Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

BMC Public Health. 2010 Mar 29;10(1):170

Authors: Turner TJ, Barnes H, Reid J, Garrubba M

ABSTRACT: BACKGROUND: It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid. METHODS: Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings. RESULTS: Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid. CONCLUSIONS: We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.

PMID: 20350326 [PubMed - as supplied by publisher]

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Adoption of practice guidelines and assessment tools in substance abuse treatment.

Subst Abuse Treat Prev Policy. 2010 Mar 26;5(1):4

Authors: Rieckmann TR, Fuller BE, Saedi GA, McCarty D

ABSTRACT: BACKGROUND: The gap between research and practice limits utilization of relevant, progressive and empirically validated strategies in substance abuse treatment. METHODS: Participants include substance abuse treatment programs from the Northeastern United States. Structural equation models were constructed with agency level data to explore two outcome variables: adoption of practice guidelines and assessment tools at two points in time; models also included organizational, staffing and service variables. RESULTS: In 1997, managed care involvement and provision of primary care services had the strongest association with increased use of assessment tools, which, along with provision of counseling services, were associated with a greater use of practice guidelines. In 2001, managed care involvement, counseling services and being a stand-alone drug treatment agency were associated with a greater use of assessment tools, which was in turn related to an increase in the use of practice guidelines. CONCLUSIONS: This study provides managers, clinicians and policy-makers with a framework for understanding factors related to the adoption of new technologies in substance abuse treatment.

PMID: 20346158 [PubMed - as supplied by publisher]

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Overview of Guidelines for Establishing a Face Transplant Program: A Work in Progress.

Am J Transplant. 2010 Mar 26;

Authors: Siemionow M, Gordon CR

Since 2005, nine face transplants have been performed in four countries: France, the United States (US), China and Spain. These encouraging short-term outcomes, with the longest survivor approaching 5 years, have led to an increased interest in establishing face transplant programs worldwide. Therefore, the purpose of this article is to facilitate the dissemination of relevant details as per our experience in an effort to assist those medical centers interested in establishing a face transplant program. In this article, we address the logistical challenges involved with face transplantation; including essential program requirements, protocol details, face transplant team assembly, project funding, the organ procurement organization and the coroner. It must be emphasized that face transplantation is still experimental and its therapeutic value remains to be validated. All surgical teams pursuing this endeavor must dedicate an attention to detail and should accept a responsibility to publish their outcomes in a transparent manner in order to contribute to the international field. However, due to its inherent complexity, facial transplantation should only be performed by university-affiliated medical institutions capable of orchestrating a specialized multidisciplinary team with a long-term commitment to its success.

PMID: 20353470 [PubMed - as supplied by publisher]

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Evidence-based guidelines for treatment of cervical cancer in Japan: Japan Society of Gynecologic Oncology (JSGO) 2007 edition.

Int J Clin Oncol. 2010 Mar 24;

Authors: Nagase S, Inoue Y, Umesaki N, Aoki D, Ueda M, Sakamoto H, Kobayashi S, Kitagawa R, Toita T, Nagao S, Hasegawa K, Fukasawa I, Fujiwara K, Watanabe Y, Ito K, Niikura H, Iwasaka T, Ochiai K, Katabuchi H, Kamura T, Konishi I, Sakuragi N, Tanaka T, Hirai Y, Hiramatsu Y, Mukai M, Yoshikawa H, Takano T, Yoshinaga K, Otsuki T, Sakuma M, Inaba N, Udagawa Y, Yaegashi N

Clinical practice guidelines for gynecologic cancers have been published by the National Comprehensive Cancer Network and the National Cancer Institute. Whereas these guidelines form the basis for the standard of care for gynecologic malignancies in the United States, it has proven difficult to institute them in Japan due to differences in patient characteristics, health-care delivery systems, and insurance programs. Therefore, evidence-based guidelines for treating cervical cancer specifically in Japan have been under development. The Guidelines Formulation Committee and Evaluation Committee were independently established within the Committee for Treatment Guidelines for Cervical Cancer. Opinions from within and outside the Japan Society of Gynecologic Oncology (JSGO) were incorporated into the final draft, and the guidelines were published after approval by the JSGO. These guidelines are composed of ten chapters and comprise three algorithms. Each chapter consists of a clinical question, recommendations, background, objectives, explanations, and references. The objective of these guidelines is to clearly delineate the standard of care for cervical cancer treatment in Japan in order to ensure equitable care for all Japanese women diagnosed with cervical cancer.

PMID: 20333431 [PubMed - as supplied by publisher]

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Quality of guideline development assessed by the Evaluation Committee of the Japan Society of Clinical Oncology.

Int J Clin Oncol. 2010 Mar 24;

Authors: Shimbo T, Fukui T, Ishioka C, Okamoto K, Okamoto T, Kameoka S, Sato A, Toi M, Matsui K, Mayumi T, Saji S, Miyazaki M, Takatsuka Y, Hirata K

BACKGROUND: The Japan Society of Clinical Oncology started implementing clinical practice guidelines for cancer in 2001. It created a Guideline Committee and has published cancer-related information in collaboration with individual subspecialty cancer societies. The society then established an Evaluation Committee to assess the quality of guidelines. METHODS: The quality of development and general characteristics of guidelines were reviewed using the AGREE instrument. The six standardized domain scores and 23-item crude scores were described, and items with a low median score or a wide inter-quartile range were explored. Kappa statistics for inter-rater reproducibility were also described. RESULTS: Domains in which the median score was >50 points in 18 guidelines developed between March 2005 and May 2009 included "scope and purpose," "rigor of development," and "clarity and presentation." Domains with a median score < 50 points were "stakeholder involvement," "applicability," and "editorial independence." Scores in all domains except "stakeholder involvement" were higher during the second half of the period than during the first half of the period, although P values were 0.10-0.93. Crude scores remained low for items 5, 7, 19, 20, 22, and 23, and the inter-quartile ranges of items 2, 6, 10, and 22 were wide. Kappa statistics ranged from -0.02 to 0.64, and they were especially low for items 3, 5, 7, 18, and 23. CONCLUSION: Guideline quality has tended to improve during the 10 years since the society started this activity. However, issues remain to be improved through continuous revisions.

PMID: 20333432 [PubMed - as supplied by publisher]

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CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.

BMC Med. 2010 Mar 24;8(1):18

Authors: Schulz KF, Altman DG, Moher D, Group C

ABSTRACT: The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.

PMID: 20334633 [PubMed - as supplied by publisher]

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CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomized Trials.

Ann Intern Med. 2010 Mar 24;

Authors: Schulz KF, Altman DG, Moher D,

The CONSORT (Consolidated Standards of Reporting Trials) statement is used worldwide to improve the reporting of randomized, controlled trials. Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience.

PMID: 20335313 [PubMed - as supplied by publisher]

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Do small group workshops and locally adapted guidelines improve asthma patients' health outcomes? A cluster randomized controlled trial.

Fam Pract. 2010 Mar 23;

Authors: Sulaiman ND, Barton CA, Liaw ST, Harris CA, Sawyer SM, Abramson MJ, Robertson C, Dharmage SC

OBJECTIVE: To improve health outcomes of children and adolescents with asthma using a multifaceted intervention for GPs. METHODS: The design of the study was a cluster randomized controlled trial. GPs were randomized at a practice level in general practice clinics in Melbourne, Australia. Participants were children/adolescents aged 2-14 years with asthma and their caregivers identified from the medical records of participating clinics. Questionnaires were completed by 411 at baseline and 341 at follow-up. The intervention arm (n = 18 GPs) participated in a small group asthma education programme and was provided with locally adapted paediatric asthma guidelines. One control arm (n = 18 GPs) received only the adapted paediatric asthma guidelines, while the other control arm (n = 15 GPs) received an unrelated educational intervention. The outcome measures of the study were children/adolescents and caregivers completed questionnaires about asthma management and control, asthma knowledge and quality of life at recruitment and 6 months later. Ownership of a written asthma action plan (WAAP) was the primary outcome. RESULTS: There was no evidence for changes in ownership of WAAPs between the three study arms. Adolescents in the intervention group reported an improvement in quality of life subscale score 'positive effects' (mean difference = 2.64, P = 0.01), but there was no evidence for an effect of the intervention on other study outcomes among the three study arms. CONCLUSIONS: The intervention was associated with some improvement in quality of life for adolescents. However, overall, the intervention did not translate into increased ownership of WAAPs, control of asthma or improved quality of life.

PMID: 20332178 [PubMed - as supplied by publisher]

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