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Developing guidelines for good practice in the economic evaluation of occupational safety and health interventions.

Scand J Work Environ Health. 2010 Apr 29;

Authors: Tompa E, Verbeek J, van Tulder M, de Boer A

OBJECTIVES: One of the objectives of a recently held workshop in Amsterdam, the Netherlands, was to advance methods for the economic evaluation of occupational safety and health (OSH) interventions at the corporate and societal level. Drawing from that workshop, we discuss issues to consider when developing guidelines for good practice (ie, a reference case). METHODS: The Economics of Occupational Safety and Health (ECOSH) workshop was held in conjunction with the Repository of Occupational Well-being Economic Research (ROWER) initiative in the fall of 2009 and brought together researchers, employers, unions, policymakers, and other stakeholders. Through presentations, break-out sessions, and group discussions, efforts were made to develop a consensus on key elements for good practice. This manuscript integrates these efforts along with earlier contributions in this area. RESULTS: We propose some framework principles and a set of recommendations to serve as the foundations for developing a reference case. We argue that a reference case can be invaluable for the OSH field because it encourages sound principles to be consistently applied in studies. Furthermore, it can ensure that studies are more readily comparable regardless of the intervention type, jurisdiction, or sector. CONCLUSIONS: Developing guidelines for good practice in the economic evaluation of OSH interventions that meet the needs of all stakeholders requires discussion as well as time. The ECOSH/ROWER initiative has served as a good starting point for this objective.

PMID: 20431858 [PubMed - as supplied by publisher]

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Patient and public involvement in clinical guidelines: international experiences and future perspectives.

Qual Saf Health Care. 2010 Apr 27;

Authors: Boivin A, Currie K, Fervers B, Gracia J, James M, Marshall C, Sakala C, Sanger S, Strid J, Thomas V, van der Weijden T, Grol R, Burgers J,

Background Clinical practice guidelines (CPG) are important tools for improving patient care. Patient and public involvement is recognised as an essential component of CPG development and implementation. The Guideline International Network Patient and Public Involvement Working Group (G-I-N PUBLIC) aims to support the development, implementation and evaluation of guideline-oriented patient and public involvement programmes (PPIPs). Objective To develop an international practice and research agenda on patient and public involvement in CPG. Method 56 CPG developers, researchers, and patient/public representatives from 14 different countries, were consulted in an international workshop. Recommendations were validated with G-I-N PUBLIC steering committee members. Results Many CPG organisations have set up PPIPs that use a range of participation, consultation and communication methods. Current PPIPs aim to improve the quality and responsiveness of CPGs to public expectations and needs, or to foster individual healthcare decisions. Some organisations use structured involvement methods, including providing training for patient and public representatives. A number of financial, organisational and sociopolitical barriers limit patient and public involvement. The paucity of process and impact evaluations limits our current understanding of the conditions under which patient and public involvement is most likely to be effective. Conclusion Greater international collaboration and research are needed to strengthen existing knowledge, development and evaluation of patient and public involvement in CPG.

PMID: 20427302 [PubMed - as supplied by publisher]

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Opioid Pharmacotherapy for Chronic Non-cancer Pain in the United States: A Research Guideline for Developing an Evidence-Base.

J Pain. 2010 Apr 27;

Authors: Chapman CR, Lipschitz DL, Angst MS, Chou R, Denisco RC, Donaldson GW, Fine PG, Foley KM, Gallagher RM, Gilson AM, Haddox JD, Horn SD, Inturrisi CE, Jick SS, Lipman AG, Loeser JD, Noble M, Porter L, Rowbotham MC, Schoelles KM, Turk DC, Volinn E, Von Korff MR, Webster LR, Weisner CM

This document reports the consensus of an interdisciplinary panel of research and clinical experts charged with reviewing the use of opioids for chronic noncancer pain (CNCP) and formulating guidelines for future research. Prescribing opioids for chronic noncancer pain has recently escalated in the United States. Contrasting with increasing opioid use are: 1) The lack of evidence supporting long-term effectiveness; 2) Escalating misuse of prescription opioids including abuse and diversion; and 3) Uncertainty about the incidence and clinical salience of multiple, poorly characterized adverse drug events (ADEs) including endocrine dysfunction, immunosuppression and infectious disease, opioid-induced hyperalgesia and xerostomia, overdose, falls and fractures, and psychosocial complications. Chief among the limitations of current evidence are: 1) Sparse evidence on long-term opioid effectiveness in chronic pain patients due to the short-term time frame of clinical trials; 2) Insufficiently comprehensive outcome assessment; and 3) Incomplete identification and quantification of ADEs. The panel called for a strategic interdisciplinary approach to the problem domain in which basic scientists and clinicians cooperate to resolve urgent issues and generate a comprehensive evidence base. It offered 4 recommendations in 3 areas: 1) A research strategy for studying the effectiveness of long-term opioid pharmacotherapy; 2) Improvements in evidence-generation methodology; and 3) Potential research topics for generating new evidence. PERSPECTIVE: Prescribing opioids for CNCP has outpaced the growth of scientific evidence bearing on the benefits and harms of these interventions. The need for a strong evidence base is urgent. This guideline offers a strategic approach to creating a comprehensive evidence base to guide safe and effective management of CNCP.

PMID: 20430701 [PubMed - as supplied by publisher]

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Transparent and accurate reporting increases reliability, utility, and impact of your research: reporting guidelines and the EQUATOR Network.

BMC Med. 2010 Apr 26;8(1):24

Authors: Simera I, Moher D, Hirst A, Hoey J, Schulz KF, Altman DG

ABSTRACT: Although current electronic methods of scientific publishing offer increased opportunities for publishing all research studies and describing them in sufficient detail, health research literature still suffers from many shortcomings. These shortcomings seriously undermine the value and utility of the literature and waste scarce resources invested in the research. In recent years there have been several positive steps aimed at improving this situation, such as a strengthening of journals' policies on research publication and the wide requirement to register clinical trials. The EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network is an international initiative set up to advance high quality reporting of health research studies; it promotes good reporting practices including the wider implementation of reporting guidelines. EQUATOR provides free online resources (www.equator-network.org) supported by education and training activities and assists in the development of robust reporting guidelines. This paper outlines EQUATOR's goals and activities and offers suggestions for organizations and individuals involved in health research on how to strengthen research reporting.

PMID: 20420659 [PubMed - as supplied by publisher]

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Is Concurrent Chemoradiation the Standard of Care for Locally Advanced Non-small Cell Lung Cancer? A Review of Guidelines and Evidence.

Clin Oncol (R Coll Radiol). 2010 Apr 26;

Authors: O'Rourke N, Macbeth F

In the past 15 years, the treatment of locally advanced non-small cell lung cancer (NSCLC) has shifted from radiotherapy alone. There are now schedules using induction chemotherapy, concurrent chemoradiation using either radiosensitising doses of chemotherapy or full-dose chemotherapy, consolidation chemotherapy after radiation or combinations of these options. There is no consensus on the optimal chemotherapy regimen and its scheduling and the issue of radiation dose and optimal fractionation equally remains unresolved. This overview is in two sections. First, we have evaluated a selection of international guidelines on the management of locally advanced NSCLC. We assessed the methodology by which individual guidelines were produced and the levels of evidence quoted in support of the recommendations. Second, we have updated the literature search of the 2004 Cochrane review on concurrent chemoradiation. Trials were identified that compared sequential with concurrent chemoradiation using median survival as the primary outcome measure. Two-year survival and toxicity were evaluated as secondary outcome measures. Eleven trials were identified, of which six fulfilled criteria for inclusion. The median survival for concurrent treatment was 16-17 months compared with 13-15 months with sequential treatment. Treatment-related mortality was 3% for concurrent treatment and 1.7% for sequential treatment. The rate of grade 3 or worse oesophagitis was 19% in concurrent treatment compared with 3% for sequential treatment. In conclusion, chemotherapy adds benefit to radiotherapy treatment of locally advanced NSCLC. Concurrent chemoradiation is associated with significant toxicity. The evidence to support concurrent chemoradiation as the standard of care is not robust, in spite of its recommendation within a number of guidelines. Further trials should be supported.

PMID: 20427167 [PubMed - as supplied by publisher]

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[Adherence to treatment guidelines for postoperative nausea and vomiting : How well does knowledge transfer result in improved clinical care?]

Anaesthesist. 2010 Apr 25;

Authors: Franck M, Radtke FM, Baumeyer A, Kranke P, Wernecke KD, Spies CD

BACKGROUND: In order to reduce the incidence of postoperative nausea and vomiting (PONV) a standard operating procedure (SOP) was developed in our department. This consists basically in the administration of one antiemetic intervention for moderate risk (2 risk factors), two interventions for high risk (3-4 risk factors) and no prophylaxis in patients who have no or only one risk factor. The aim of this study was to find out whether PONV prophylaxis according to our SOP was followed and led to a lower incidence of PONV. METHOD AND PATIENTS: A total of 2,729 patients were examined in a prospective observational study with post-ad hoc analysis in our department. Inclusion criteria were age over 14 years after general anesthesia and postoperative care in the recovery room. This group was examined in relation to compliance with the SOP. RESULTS: A total of 725 (26.6%), 1050 (38.5%) and 954 (35.0%) patients were grouped according to risk classification into groups with low, medium and high risks, respectively. An SOP compliant regime occurred in 668 patients (92.1%) of the low risk groups, in 373 patients (35.6%) of the moderate risk group and 177 patients (18.6%) of patients at high risk for PONV. In the high risk group 565 patients (59.2%) received at least one antiemetic medication. Patients with PONV were on average cared for 12 min longer in the recovery room (p=0.048). CONCLUSION: Patients with medium and high risk have a lower incidence of PONV than expected per risk calculation by complying with the SOP. However, the recommended risk-adapted approach was inadequately implemented. Considering this there is room for improvement. Moreover taking into account these implementation issues a general PONV prophylaxis may be beneficial.

PMID: 20419282 [PubMed - as supplied by publisher]

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SELECT: evaluation and implementation of clinical practice guidelines: a guidance document from the American Professional Wound Care Association.

Adv Skin Wound Care. 2010 Apr;23(4):161-8

Authors:

PMID: 20299842 [PubMed - in process]

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Does Guideline-Adherent Therapy Improve the Outcome for Early-Onset Breast Cancer Patients?

Oncology. 2010 Apr 23;78(3-4):189-195

Authors: Varga D, Wischnewsky M, Atassi Z, Wolters R, Geyer V, Strunz K, Kreienberg R, Woeckel A

Background and Objective: Guidelines for the treatment of early-onset breast cancer have been proposed in several countries, but to date, their impact on outcomes is unverified. The objective of this study was to evaluate the association between guideline-adherent versus nonadherent treatment and recurrence-free survival (RFS) and overall survival (OAS) in early-onset breast cancer patients. Methods: A total of 1,778 patients were included in the study, of whom 111 were 35 years or younger and 1,667 were between 36 and 55 years. RFS and OAS were compared between the two groups, with respect to multiple parameters. All survival data were adjusted for tumor characteristics and analyzed with respect to guideline adherence according to the German Step 3 guidelines. Results: Statistically significant differences between the two groups (<35 years, 36-55 years) were observed with regard to breast surgery (p = 0.002) and hormone therapy (p = 0.006). Both groups were treated identically in terms of guideline adherence concerning axillary dissection (p = 0.9), radiation therapy (p = 0.7) and chemotherapy (p = 0.556). Young breast cancer patients whose treatment adhered to guideline recommendations had increased RFS and OAS [RFS: p = 0.030, hazard ratio (HR) 2.95, 95% confidence interval (CI) 1.11-7.83; OAS: p

PMID: 20414007 [PubMed - as supplied by publisher]

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Implementing the 2005 American Heart Association Guidelines Improves Outcomes after Out-of-Hospital Cardiac Arrest.

Heart Rhythm. 2010 Apr 23;

Authors: Aufderheide TP, Yannopoulos D, Lick CJ, Myers B, Romig LA, Stothert JC, Barnard J, Vartanian L, Pilgrim AJ, Benditt DG

OBJECTIVE:: The study's purpose was to determine if applying highly recommended changes in the 2005 American Heart Association (AHA) Guidelines would improve outcomes after out-of-hospital cardiac arrest. BACKGROUND:: In 2005, AHA recommended multiple ways to improve circulation during cardiopulmonary resuscitation (CPR). METHODS:: Conglomerate quality assurance data were analyzed during prospective implementation of the 2005 AHA Guidelines in five emergency medical services (EMS) systems. All EMS personnel were trained in the key new aspects of the 2005 AHA Guidelines, including use of an impedance threshold device. The primary outcome was survival to hospital discharge. Secondary outcomes were return of spontaneous circulation (ROSC), survival by initial cardiac arrest rhythm, and the cerebral performance category (CPC) score at hospital discharge. RESULTS:: There were 1605 patients in the intervention group and 1641 patients in the control group. Demographics, the rate of bystander CPR, and time from the 911 call for help to arrival of EMS personnel were similar between groups. Survival to hospital discharge was 10.1% in the control group versus 13.1% in the intervention group, (P=0.007). For patients with a presenting rhythm of ventricular fibrillation/ventricular tachycardia, survival to discharge was 20% in controls versus 32.3% in the intervention group, (P<0.001). Survival to discharge with a CPC classification of 1 or 2 was 33.3% (10/30) in the control versus 59.6% (31/52) in the intervention group, (P=0.038). CONCLUSIONS:: Compared with controls, patients with out-of-hospital cardiac arrest treated with a renewed emphasis on improved circulation during CPR had significantly higher neurologically intact hospital discharge rates.

PMID: 20420938 [PubMed - as supplied by publisher]

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Effects of a school-based intervention on adherence of 7-9-year-olds to food-based dietary guidelines and intake of nutrients.

Public Health Nutr. 2010 Apr 22;:1-11

Authors: Kristjansdottir AG, Johannsson E, Thorsdottir I

OBJECTIVE: To assess the effects of a school-based intervention on the diets of 7-9-year-olds. DESIGN: Dietary intake of children in second and fourth grades was assessed with 3d weighed dietary records in autumn 2006 and autumn 2008, before and after a school-based intervention that started in the middle of second grade, and compared with control schools with no intervention. The diet was evaluated by comparison with food-based dietary guidelines (FBDG) and reference values for nutrient intake. The intervention aimed at several determinants of intake: knowledge, awareness, preferences/taste, self-efficacy and parental influence. Nutrition education material was developed for the intervention and implemented in collaboration with teachers. The main focus of the intervention was on fruit and vegetable intake as the children's intake was far from meeting the FBDG on fruit and vegetables at baseline. SETTING: Elementary schools in Reykjavik, Iceland. SUBJECTS: Complete dietary records were available for 106 children both at baseline and follow-up. RESULTS: Total fruit and vegetable intake increased by 47 % in the intervention schools (mean: 61.3 (sd 126.4) g/d) and decreased by 27 % in the control schools (mean: 46.5 (sd 105.3) g/d; P < 0.001). The majority of the children in the intervention schools did still not meet the FBDG on fruits and vegetables at follow-up. Fibre intake increased significantly in the intervention schools, as well as that of potassium, magnesium, beta-carotene and vitamin C (borderline). CONCLUSIONS: The school-based intervention in 7-9-year-olds was effective in increasing fruit and vegetable intake, by 47 % increase from baseline, which was mirrored in nutrient intake.

PMID: 20409359 [PubMed - as supplied by publisher]

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